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General NPI Number Information
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NPI Number | 1558638296
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL CARE
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 2695 N MILITARY TRL STE 26
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-2946
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Country | US
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Telephone | 561-899-3180
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Fax | 561-899-3179
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Provider Business Mailing Address
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Address Line | 2695 N MILITARY TRL STE 26
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-2946
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Country | US
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Telephone | 561-899-3180
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Fax | 561-899-3179
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. OSLY PHILISTIN
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Credential | DC
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Telephone | 561-899-3180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH9111
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License Number State | FL
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