1750649687 NPI number — VITALITY 4U2 CHIROPRACTIC CARE FOR THE WHOLE FAMILY, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750649687 NPI number — VITALITY 4U2 CHIROPRACTIC CARE FOR THE WHOLE FAMILY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITALITY 4U2 CHIROPRACTIC CARE FOR THE WHOLE FAMILY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750649687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2215 N 72ND CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMWOOD PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60707-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-842-1968
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345A W OGDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTMONT
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60559-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-842-1968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PEPPERS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
PRESIDENT/CHIROPRACTOR
Authorized Official Telephone Number:
630-842-1968

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038.012098 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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