Provider Demographics
NPI:1982997516
Name:VITALITY CHIROPRACTIC CENTER PLC
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC CENTER PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-402-3418
Mailing Address - Street 1:600 S BEACON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2178
Mailing Address - Country:US
Mailing Address - Phone:616-402-3418
Mailing Address - Fax:616-743-5945
Practice Address - Street 1:600 S BEACON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2178
Practice Address - Country:US
Practice Address - Phone:616-402-3418
Practice Address - Fax:616-743-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty