Provider Demographics
NPI:1225403355
Name:VITALISTIC CHIROPRACTIC PC
Entity type:Organization
Organization Name:VITALISTIC CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:HIMSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-773-7820
Mailing Address - Street 1:14350 MUNDY DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-7256
Mailing Address - Country:US
Mailing Address - Phone:317-773-7820
Mailing Address - Fax:
Practice Address - Street 1:14350 MUNDY DR STE 1000
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-7256
Practice Address - Country:US
Practice Address - Phone:317-773-7820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty