NPIMap

Organization Active NPI

Optimal Chiropractic Family Sports Rehab Inc

  • Chiropractor
  • Crown Point, IN
National Provider Identifier
1508248642
Registry record updated Oct 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
OPTIMAL CHIROPRACTIC FAMILY SPORTS REHAB INC
Practice address
11420 Broadway
Crown Point, IN 46307-7106
Phone
(219) 661-8680
Fax
(219) 661-8280
NPI assigned
Jun 25, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2023

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

Authorized official

Name
Dr. Ashley Renee Nelson, DC, FNPNPI 1871985010
Title
Owner/Physician
Phone
(219) 661-8680

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

11420 Broadway
Crown Point, IN 46307-7106

Mailing address

11420 Broadway
Crown Point, IN 46307-7106
Phone (219) 661-8680

Other names 1

  • Optimal Chiropractic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150702000886 IN Part B Supplier - Clinic/Group Practice 8628380748 Receives reassigned benefits from 1 practitioner
Practice locations: Crown Point, IN

National Provider Directory

National Provider Directory

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697846400000",
    "number": "1508248642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11420 BROADWAY",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077106",
            "telephone_number": "219-661-8680",
            "fax_number": "219-661-8280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11420 BROADWAY",
            "city": "CROWN POINT",
            "state": "IN",
            "postal_code": "463077106",
            "telephone_number": "219-661-8680",
            "fax_number": "219-661-8280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL CHIROPRACTIC FAMILY SPORTS REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-25",
        "last_updated": "2023-10-21",
        "certification_date": "2023-10-21",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "219-661-8680",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, FNP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimal Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optimal Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crown Point, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2023; 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.