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General NPI Number Information
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NPI Number | 1770701310
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH CHIROPRACTIC CENTER, PA
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 191 WOODPORT RD. UNIT 13A
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City | SPARTA
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State | NJ
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Zip | 07871-2610
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Country | US
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Telephone | 973-729-8884
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Fax | 973-729-8406
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Provider Business Mailing Address
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Address Line | 191 WOODPORT RD. UNIT 13A
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City | SPARTA
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State | NJ
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Zip | 07871-2610
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Country | US
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Telephone | 973-729-8884
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Fax | 973-729-8406
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD JOSEPH SANTANGELO
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Credential | D.C.
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Telephone | 973-729-8884
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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 | MC04102
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License Number State | NJ
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