Provider Demographics
NPI:1588322002
Name:VITALITY CHIROPRACTIC
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:LEIF
Authorized Official - Last Name:ERIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-699-6010
Mailing Address - Street 1:3850 W MAIN ST STE 804
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1071
Mailing Address - Country:US
Mailing Address - Phone:334-699-6010
Mailing Address - Fax:
Practice Address - Street 1:3850 W MAIN ST STE 804
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1071
Practice Address - Country:US
Practice Address - Phone:334-699-6010
Practice Address - Fax:334-699-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty