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General NPI Number Information
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NPI Number | 1710523683
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Entity Type | Organization
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Legal Business Name | OPTIMUM SPINE CHIROPRACTIC CENTER INC
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 7500 NW 104TH AVE STE B200
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City | DORAL
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State | FL
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Zip | 33178-3373
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Country | US
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Telephone | 305-204-2243
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Fax |
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Provider Business Mailing Address
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Address Line | 7500 NW 104TH AVE STE B200
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City | DORAL
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State | FL
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Zip | 33178-3373
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Country | US
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Telephone | 305-204-2243
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | ALEX OSORIO
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Credential |
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Telephone | 305-874-9851
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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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