Provider Demographics
NPI:1730342353
Name:OPTIMUM HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:OPTIMUM HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BUTT
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:630-920-8203
Mailing Address - Street 1:200 E CHICAGO AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1746
Mailing Address - Country:US
Mailing Address - Phone:630-920-8203
Mailing Address - Fax:630-920-8203
Practice Address - Street 1:200 E CHICAGO AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1746
Practice Address - Country:US
Practice Address - Phone:630-920-8203
Practice Address - Fax:630-920-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-007751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL378820Medicare UPIN