Provider Demographics
NPI:1588768212
Name:THE CENTER FOR OPTIMUM WELLNESS PA
Entity type:Organization
Organization Name:THE CENTER FOR OPTIMUM WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORRI
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-623-6305
Mailing Address - Street 1:5433 WESTHEIMER RD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5322
Mailing Address - Country:US
Mailing Address - Phone:713-623-6305
Mailing Address - Fax:713-840-7909
Practice Address - Street 1:5433 WESTHEIMER RD
Practice Address - Street 2:SUITE 411
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5322
Practice Address - Country:US
Practice Address - Phone:713-623-6305
Practice Address - Fax:713-840-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T12741Medicare UPIN
601864Medicare PIN