Provider Demographics
NPI:1528165628
Name:VITALIS, NEAL B (DC)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:B
Last Name:VITALIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26708 180TH AVE SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4969
Mailing Address - Country:US
Mailing Address - Phone:253-630-9777
Mailing Address - Fax:253-630-9806
Practice Address - Street 1:26708 180TH AVE SE
Practice Address - Street 2:SUITE 102
Practice Address - City:COVINGTON
Practice Address - State:WA
Practice Address - Zip Code:98042-4969
Practice Address - Country:US
Practice Address - Phone:253-630-9777
Practice Address - Fax:253-630-9806
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0186869OtherDEPT. OF LABOR & I
WA3246VIOtherREGENCE
WA0186869OtherDEPT. OF LABOR & I