MEDICARE: OPTIMAL HEALTH CHIROPRACTIC 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
1	111N00000X	Chiropractor	5812	CO

General Provider Information

NPI Number	:	1801840319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL HEALTH CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	4284 TRAIL BOSS DR
Second Line	:	SUITE 120
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-0454
Fax Number	:	303-688-9998

Provider Business Practice Location Address
First Line	:	4284 TRAIL BOSS DR
Second Line	:	SUITE 120
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7512
Country	:	US
Telephone Number	:	303-688-0454
Fax Number	:	303-688-9998

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEREK SCOTT VAUGHN
Credential	:	D.C.
Telephone Number	:	303-482-7227

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	08/22/2020

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