MEDICARE: OPTIMUM CHIROPRACTIC PC

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
1	111N00000X	Chiropractor	007464	IA

General Provider Information

NPI Number	:	1629354832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	7205 VISTA DR
Second Line	:	SUITE 104
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-9360
Country	:	US
Telephone Number	:	515-225-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 VISTA DR
Second Line	:	SUITE 104
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-9360
Country	:	US
Telephone Number	:	515-225-9200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRETT MATTHEW VOWLES
Credential	:	D.C.
Telephone Number	:	515-225-9200

Provider Enumeration Date	:	11/01/2011
Last Update Date	:	06/06/2019

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