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General NPI Number Information
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NPI Number | 1801409503
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Entity Type | Organization
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Legal Business Name | OPTIMAL CARE CHIROPRACTIC
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Dates
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Enumeration Date | 08/24/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 2759 US HIGHWAY 34
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City | OSWEGO
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State | IL
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Zip | 60543-8949
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Country | US
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Telephone | 630-699-5086
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Fax | 630-982-6550
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Provider Business Mailing Address
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Address Line | 2759 US HIGHWAY 34
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City | OSWEGO
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State | IL
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Zip | 60543-8949
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Country | US
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Telephone | 630-699-5086
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Fax | 630-982-6550
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NANCY PORTILLO
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Credential | DC
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Telephone | 630-699-5086
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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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