Provider Demographics
NPI:1528629631
Name:VIBRANT LIFE FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:VIBRANT LIFE FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:608-849-4464
Mailing Address - Street 1:204 S CENTURY AVE STE A3
Mailing Address - Street 2:
Mailing Address - City:WAUNAKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53597-1272
Mailing Address - Country:US
Mailing Address - Phone:608-849-4464
Mailing Address - Fax:608-849-4428
Practice Address - Street 1:204 S CENTURY AVE STE A3
Practice Address - Street 2:
Practice Address - City:WAUNAKEE
Practice Address - State:WI
Practice Address - Zip Code:53597-1272
Practice Address - Country:US
Practice Address - Phone:608-849-4464
Practice Address - Fax:608-849-4428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty