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General NPI Number Information
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NPI Number | 1750971404
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH CLINIC INC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 28315 S TAMIAMI TRL STE 101
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3217
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Country | US
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Telephone | 239-947-1177
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Fax |
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Provider Business Mailing Address
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Address Line | 28315 S TAMIAMI TRL STE 101
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-3217
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Country | US
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Telephone | 239-947-1177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY GENDRON
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Credential | DC
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Telephone | 235-947-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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