Provider Demographics
NPI:1992133961
Name:ADVANCED VITALITY CHIROPRACTIC & WELLNESS LLC
Entity type:Organization
Organization Name:ADVANCED VITALITY CHIROPRACTIC & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-570-2666
Mailing Address - Street 1:3 MEDICAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4167
Mailing Address - Country:US
Mailing Address - Phone:806-570-2666
Mailing Address - Fax:682-201-2226
Practice Address - Street 1:3 MEDICAL DR STE B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4167
Practice Address - Country:US
Practice Address - Phone:806-570-2666
Practice Address - Fax:682-201-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center