St. Louis Optimal Performance, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2012014238 Issued in MO

Legal business name

ST. LOUIS OPTIMAL PERFORMANCE, LLC

Practice address

219 Chesterfield Towne Ctr
Chesterfield, MO 63005-1257

Phone

(636) 778-9997

Fax

(636) 778-9994

NPI assigned

Nov 15, 2012

Organization subpart

Yes

Parent organization

ST. LOUIS OPTIMAL PERFORMANCEAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brian Andrew Laiderman, D.C.NPI 1568724094

Title

Chiropractic Physician/Owner

Phone

(636) 778-9997

Specialties & licenses 1

Addresses

Other names 1

• Optimal Performance Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Part of

St Louis Optimal Perf LLC

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Brian Laiderman, D.C.

  • Sports Physician Chiropractor
  • Chesterfield, MO
  • NPI 1568724094
  Medicare reassignment Care Compare group NPD Authorized official
• Joshua B Luitjohan, DC

  • Chiropractor
  • Boulder, CO
  • NPI 1437645231

  MO

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372723200000",
    "number": "1245574367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 CHESTERFIELD TOWNE CTR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051257",
            "telephone_number": "636-778-9997",
            "fax_number": "636-778-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 CHESTERFIELD TOWNE CTR",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051257",
            "telephone_number": "636-778-9997",
            "fax_number": "636-778-9994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS OPTIMAL PERFORMANCE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. LOUIS OPTIMAL PERFORMANCE",
        "enumeration_date": "2012-11-15",
        "last_updated": "2013-07-02",
        "status": "A",
        "authorized_official_last_name": "LAIDERMAN",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "CHIROPRACTIC PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "636-778-9997",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2012014238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Performance Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Chesterfield, MO
• Providers in Chesterfield, MO by specialty
• Chiropractor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.