Provider Demographics
NPI:1801570742
Name:OPTIMUM PERFORMANCE CHIROPRACTIC & WELLNESS LLC.
Entity type:Organization
Organization Name:OPTIMUM PERFORMANCE CHIROPRACTIC & WELLNESS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:FERRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-786-6139
Mailing Address - Street 1:1301 SHILOH RD NW STE 420
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7152
Mailing Address - Country:US
Mailing Address - Phone:470-308-4108
Mailing Address - Fax:
Practice Address - Street 1:11130 STATE BRIDGE RD STE C102
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-2640
Practice Address - Country:US
Practice Address - Phone:770-521-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUM PERFORMANCE CHIROPRACTIC & WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty