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General NPI Number Information
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NPI Number | 1801840319
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH CHIROPRACTIC INC.
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4284 TRAIL BOSS DR SUITE 120
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City | CASTLE ROCK
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State | CO
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Zip | 80104-7512
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Country | US
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Telephone | 303-688-0454
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Fax | 303-688-9998
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Provider Business Mailing Address
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Address Line | 4284 TRAIL BOSS DR SUITE 120
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City | CASTLE ROCK
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State | CO
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Zip | 80104-7512
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Country | US
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Telephone | 303-688-0454
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Fax | 303-688-9998
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEREK SCOTT VAUGHN
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Credential | D.C.
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Telephone | 303-482-7227
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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 | 5812
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License Number State | CO
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