NPIMap

Organization Active NPI

Optimized Living Institute

  • Nutrition Chiropractor
  • Baton Rouge, LA
National Provider Identifier
1922404151
Registry record updated Nov 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nutrition ChiropractorTaxonomy code 111NN1001X
License
12675 Issued in TX
Legal business name
OPTIMIZED LIVING INSTITUTE
Practice address
8775 Jefferson Highway
Suite E
Baton Rouge, LA 70809
Phone
(225) 339-9911
Fax
(225) 308-9225
NPI assigned
Nov 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2019

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

Authorized official

Name
Dr. Derek Paul Bruner, D.C.
Title
Co-Owner
Phone
(225) 339-9911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NN1001X 12675 TX Primary

Addresses

Primary practice location

8775 Jefferson Highway
Suite E
Baton Rouge, LA 70809

Mailing address

4700 Millwood Dr. #77559
Baton Rouge, LA 70879-7559
Phone (225) 339-9911

Other practice location 1

1330 S Magnolia St Ste B
Hammond, LA 70403-5080
Phone (985) 222-2066

Other names 1

  • Optimized Living Institute Doing business as

National Provider Directory

National Provider Directory

Locations

4700 Millwood Dr
Unit 77559
Baton Rouge, LA 70879
Phone (225) 339-9911

8775 Jefferson Hwy
Ste E
Baton Rouge, LA 70809
Phone (225) 339-9911

Practitioners & affiliated clinicians

Practitioners 2

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": "1416182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574208000000",
    "number": "1922404151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MILLWOOD DR. #77559",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708797559",
            "telephone_number": "225-339-9911",
            "fax_number": "225-308-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8775 JEFFERSON HIGHWAY",
            "address_2": "SUITE E",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70809",
            "telephone_number": "225-339-9911",
            "fax_number": "225-308-9225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1330 S Magnolia St Ste B",
            "address_purpose": "LOCATION",
            "city": "Hammond",
            "state": "LA",
            "postal_code": "704035080",
            "country_code": "US",
            "telephone_number": "985-222-2066",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OPTIMIZED LIVING INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-17",
        "last_updated": "2019-11-20",
        "status": "A",
        "authorized_official_last_name": "BRUNER",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "225-339-9911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "TX",
            "license": "12675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optimized Living Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optimized Living Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.