Provider Demographics
NPI:1609247923
Name:OPTIMAL CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:OPTIMAL CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JAHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-260-2976
Mailing Address - Street 1:3220 4TH ST E STE 101
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-3082
Mailing Address - Country:US
Mailing Address - Phone:701-364-9998
Mailing Address - Fax:701-364-5666
Practice Address - Street 1:3220 4TH ST E STE 101
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-3082
Practice Address - Country:US
Practice Address - Phone:701-364-9998
Practice Address - Fax:701-364-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty