Provider Demographics
NPI:1336389097
Name:VITALITY HEALTH CENTER
Entity type:Organization
Organization Name:VITALITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-573-7788
Mailing Address - Street 1:1175 E OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-4805
Mailing Address - Country:US
Mailing Address - Phone:630-983-8455
Mailing Address - Fax:630-983-8452
Practice Address - Street 1:1175 E OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4805
Practice Address - Country:US
Practice Address - Phone:630-983-8455
Practice Address - Fax:630-983-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214243Medicare PIN