Provider Demographics
NPI:1770907107
Name:VITALITY CHIROPRACTIC FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-258-8462
Mailing Address - Street 1:1379 MCANSH SQ
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-5620
Mailing Address - Country:US
Mailing Address - Phone:941-258-8462
Mailing Address - Fax:
Practice Address - Street 1:2650 BAHIA VISTA ST STE 304
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2634
Practice Address - Country:US
Practice Address - Phone:941-777-3375
Practice Address - Fax:941-451-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty