| Organization Name: | OPTIMAL CHIROPRACTIC FAMILY SPORTS REHAB INC |
| NPI Number: | 1508248642 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ASHLEY RENEE NELSON (OWNER/PHYSICIAN) |
| Mailing Address: | 11400 Broadway Crown Point |
| State: | IN US |
| Postal Code: | 463077106 |
| Phone Number: | 2196618680 |
| Fax Number: | 2196618280 |
| NPI Enumeration Date: | 06/25/2015 |
| NPI Last Update Date: | 06/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 08002815A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |