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NPI Code Detail

MEDICARE: OPTIMAL SPINE & HEALTH MEDICAL CENTER, INC.

MEDICARE: OPTIMAL SPINE & HEALTH MEDICAL CENTER, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC15972CA
2208D00000XGeneral Practice PhysicianC51512CA

General Provider Information

NPI Number : 1073749495
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTIMAL SPINE & HEALTH MEDICAL CENTER, INC.
Provider Business Mailing Address
First Line : 2361 S AZUSA AVE
Second Line :
City : WEST COVINA
State : CA
Zip : 91792-1537
Country : US
Telephone Number : 626-965-2334
Fax Number : 626-964-6504
Provider Business Practice Location Address
First Line : 2361 S AZUSA AVE
Second Line :
City : WEST COVINA
State : CA
Zip : 91792-1537
Country : US
Telephone Number : 626-965-2334
Fax Number : 626-964-6504
Authorized Official
Title or Position : PRESIDENT
Name : DR. ANDREW JOSEPH KEITH
Credential : D.C.
Telephone Number : 626-965-2334
Provider Enumeration Date : 06/01/2009
Last Update Date : 01/09/2012

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Directions to “OPTIMAL SPINE & HEALTH MEDICAL CENTER, INC. ” Practice Location

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