Provider Demographics
NPI:1023390903
Name:VITALITY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:VITALITY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:HULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-989-3338
Mailing Address - Street 1:6812 N ORACLE ROAD
Mailing Address - Street 2:144
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4258
Mailing Address - Country:US
Mailing Address - Phone:520-989-3338
Mailing Address - Fax:
Practice Address - Street 1:6812 N ORACLE RD
Practice Address - Street 2:144
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4246
Practice Address - Country:US
Practice Address - Phone:520-989-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty