Provider Demographics
NPI:1548478795
Name:VITALITA CHIROPRACTIC & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:VITALITA CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEARHOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-817-0544
Mailing Address - Street 1:1860 SANDY PLAINS RD
Mailing Address - Street 2:SUITE 204-166
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7833
Mailing Address - Country:US
Mailing Address - Phone:770-817-0544
Mailing Address - Fax:770-817-0545
Practice Address - Street 1:770 OLD ROSWELL PL
Practice Address - Street 2:D-400
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1670
Practice Address - Country:US
Practice Address - Phone:770-817-0544
Practice Address - Fax:770-817-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty