Provider Demographics
NPI:1538567607
Name:OPTIMAL HEALTH CHIROPRACTIC & SPORTS INJURY
Entity type:Organization
Organization Name:OPTIMAL HEALTH CHIROPRACTIC & SPORTS INJURY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-415-2821
Mailing Address - Street 1:3069 ENGLISH CREEK AVE
Mailing Address - Street 2:OFFICE # 201
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-9708
Mailing Address - Country:US
Mailing Address - Phone:609-415-2821
Mailing Address - Fax:970-827-6588
Practice Address - Street 1:3069 ENGLISH CREEK AVE
Practice Address - Street 2:OFFICE # 201
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-415-2821
Practice Address - Fax:973-827-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-05
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00708500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty