Provider Demographics
NPI:1679398341
Name:OPTIMAL PERFORMANCE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:OPTIMAL PERFORMANCE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:OBERMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-852-5482
Mailing Address - Street 1:61539 SE JENNIFER LN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3892
Mailing Address - Country:US
Mailing Address - Phone:541-852-5482
Mailing Address - Fax:
Practice Address - Street 1:1725 SW CHANDLER AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3249
Practice Address - Country:US
Practice Address - Phone:541-852-5482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty