Provider Demographics
NPI:1386173615
Name:OPTIMUM LIFE HEALTH CENTER LLC
Entity type:Organization
Organization Name:OPTIMUM LIFE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAASSEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-223-8266
Mailing Address - Street 1:1800 W WOOLBRIGHT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6398
Mailing Address - Country:US
Mailing Address - Phone:561-572-3542
Mailing Address - Fax:
Practice Address - Street 1:15280 S JOG RD STE D
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2169
Practice Address - Country:US
Practice Address - Phone:561-223-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty