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General NPI Number Information
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NPI Number | 1629354832
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Entity Type | Organization
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Legal Business Name | OPTIMUM CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 7205 VISTA DR SUITE 104
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City | WEST DES MOINES
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State | IA
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Zip | 50266-9360
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Country | US
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Telephone | 515-225-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 7205 VISTA DR SUITE 104
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City | WEST DES MOINES
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State | IA
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Zip | 50266-9360
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Country | US
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Telephone | 515-225-9200
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRETT MATTHEW VOWLES
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Credential | D.C.
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Telephone | 515-225-9200
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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 | 007464
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License Number State | IA
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