Provider Demographics
NPI:1093503450
Name:VITAL ROOTS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VITAL ROOTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CORMANY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-370-6984
Mailing Address - Street 1:200 NORTHPOINTE CIR STE 203
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7861
Mailing Address - Country:US
Mailing Address - Phone:614-370-6984
Mailing Address - Fax:
Practice Address - Street 1:200 NORTHPOINTE CIR STE 203
Practice Address - Street 2:
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7861
Practice Address - Country:US
Practice Address - Phone:614-370-6984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty