Provider Demographics
NPI:1194132043
Name:OPTIMAL INNATE LIFE ENERGY CHIROPRACTIC PC
Entity type:Organization
Organization Name:OPTIMAL INNATE LIFE ENERGY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:312-714-2292
Mailing Address - Street 1:24510 W LOCKPORT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2312
Mailing Address - Country:US
Mailing Address - Phone:815-577-3377
Mailing Address - Fax:815-824-4337
Practice Address - Street 1:24510 W LOCKPORT ST STE 102
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2312
Practice Address - Country:US
Practice Address - Phone:815-577-3377
Practice Address - Fax:815-824-4337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty