Provider Demographics
NPI:1043826266
Name:OPTIMAL HEALTH AND PERFORMANCE
Entity type:Organization
Organization Name:OPTIMAL HEALTH AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:484-462-0969
Mailing Address - Street 1:7039 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1705
Mailing Address - Country:US
Mailing Address - Phone:610-733-7551
Mailing Address - Fax:
Practice Address - Street 1:7039 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1705
Practice Address - Country:US
Practice Address - Phone:484-462-0969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty