MEDICARE: OPTIMUM HEALTH CHIROPRACTIC & WELLNESS 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
1	111N00000X	Chiropractor	038-009778	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	205967	OTHER		MEDICARE PROVIDER #
4	P00091070	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01633148	OTHER	IL	BCBSIL

General Provider Information

NPI Number	:	1942269139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HEALTH CHIROPRACTIC & WELLNESS CENTER, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1665
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-7665
Country	:	US
Telephone Number	:	708-331-9881
Fax Number	:	708-331-9876

Provider Business Practice Location Address
First Line	:	841 E 162ND ST
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-2465
Country	:	US
Telephone Number	:	708-331-9881
Fax Number	:	708-331-9876

Authorized Official
Title or Position	:	CHIROPRACTOR OWNER
Name	:	MS. ROSEMARY CHAVIS
Credential	:	D.C.
Telephone Number	:	708-331-9881

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	01/13/2010

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Directions to “OPTIMUM HEALTH CHIROPRACTIC & WELLNESS CENTER, INC. ” Practice Location

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