Provider Demographics
NPI:1336787852
Name:OPTIMAL HEALTH & PERFORMANCE, LLC
Entity type:Organization
Organization Name:OPTIMAL HEALTH & PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MAINORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-644-2686
Mailing Address - Street 1:13 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2433
Mailing Address - Country:US
Mailing Address - Phone:931-651-1390
Mailing Address - Fax:
Practice Address - Street 1:13 N OAK AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2433
Practice Address - Country:US
Practice Address - Phone:931-651-1390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty