Provider Demographics
NPI:1528623311
Name:VIBRANT FAMILY WELLNESS LLC
Entity type:Organization
Organization Name:VIBRANT FAMILY WELLNESS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-461-3689
Mailing Address - Street 1:720 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2839
Mailing Address - Country:US
Mailing Address - Phone:507-461-3689
Mailing Address - Fax:
Practice Address - Street 1:109 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-3040
Practice Address - Country:US
Practice Address - Phone:507-571-2566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-07
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty