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General NPI Number Information
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NPI Number | 1659644144
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Entity Type | Organization
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Legal Business Name | OPTIMUM HEALTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 02/15/2012
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 3000 AMERICAN WAY
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City | MISSOULA
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State | MT
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Zip | 59808-1677
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Country | US
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Telephone | 406-317-1014
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16718
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City | MISSOULA
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State | MT
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Zip | 59808-6718
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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 | SOLE MEMBER
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Name | JEFFREY ENGEL
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Credential | DC
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Telephone | 406-317-1014
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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 | 1277
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License Number State | MT
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