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General NPI Number Information
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NPI Number | 1952501520
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Entity Type | Organization
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Legal Business Name | OPTIMA HEALTH & VITALITY CENTER
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 3321 GOLF RD STE A
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City | EAU CLAIRE
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State | WI
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Zip | 54701-9190
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Country | US
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Telephone | 715-832-1953
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Fax |
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Provider Business Mailing Address
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Address Line | 3321 GOLF RD STE A
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City | EAU CLAIRE
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State | WI
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Zip | 54701-9190
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Country | US
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Telephone | 715-832-1953
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | YVONNE A RUNKEL
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Credential |
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Telephone | 715-832-1953
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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 | 3389
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4243
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2844-012
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1708
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License Number State |
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