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General NPI Number Information
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NPI Number | 1649504341
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Entity Type | Organization
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Legal Business Name | OPTIMAL LIVING LLC
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 18471 E QUEEN CREEK RD STE 102
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-3628
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Country | US
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Telephone | 480-279-3960
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Fax | 480-279-3961
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Provider Business Mailing Address
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Address Line | 18521 E QUEEN CREEK RD STE 105-430
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-5845
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENT EARL HIRSCHI
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Credential |
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Telephone | 480-600-1394
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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 |
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License Number State |
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