NPIMap

Organization Active NPI

Optimal Health Chiropractic PLLC

  • Chiropractor
  • Clemmons, NC
National Provider Identifier
1902126014
Registry record updated Jan 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3276 Issued in NC
Legal business name
OPTIMAL HEALTH CHIROPRACTIC PLLC
Practice address
2575 Old Glory Rd Ste 300
Clemmons, NC 27012-9585
Phone
(336) 712-4100
Fax
(336) 712-4144
NPI assigned
Jun 11, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2020

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

Authorized official

Name
Adam Jon Williams, D.C.NPI 1972583862
Title
President
Phone
(336) 712-4100

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3276 NC Primary

Addresses

Primary practice location

2575 Old Glory Rd Ste 300
Clemmons, NC 27012-9585

Mailing address

2575 Old Glory Rd Ste 300
Clemmons, NC 27012-9585
Phone (336) 712-4100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100706000157 NC Part B Supplier - Clinic/Group Practice 0244361368 Receives reassigned benefits from 2 practitioners
Practice locations: Clemmons, NC

National Provider Directory

National Provider Directory
Tax ID family
Optimal Health Chiropractic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2575 Old Glory Rd
Ste 300
Clemmons, NC 27012
Phone (336) 712-4100

Practitioners & affiliated clinicians

Practitioners 3

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": "1276214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579478400000",
    "number": "1902126014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 OLD GLORY RD STE 300",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129585",
            "telephone_number": "336-712-4100",
            "fax_number": "336-712-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2575 OLD GLORY RD STE 300",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270129585",
            "telephone_number": "336-712-4100",
            "fax_number": "336-712-4144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HEALTH CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-11",
        "last_updated": "2020-01-20",
        "certification_date": "2020-01-20",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-712-4100",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2020; 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.