MEDICARE: OPTIMAL CHIROPRACTIC

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	261QH0100X	Health Service Clinic/Center	DC33749	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1609310119	OTHER	CA	NATIONAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1861910010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL CHIROPRACTIC

Provider Business Mailing Address
First Line	:	760 LAS POSAS RD STE A3
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2910
Country	:	US
Telephone Number	:	805-482-0105
Fax Number	:	805-482-0205

Provider Business Practice Location Address
First Line	:	760 LAS POSAS RD STE A3
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-2910
Country	:	US
Telephone Number	:	805-482-0105
Fax Number	:	805-482-0205

Authorized Official
Title or Position	:	DR.
Name	:	DR. KASSANDRA WALKOWIAK
Credential	:	DC
Telephone Number	:	805-482-0105

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	07/21/2022

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Directions to “OPTIMAL CHIROPRACTIC ” Practice Location

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