Provider Demographics
NPI:1033472980
Name:VITAL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:VITAL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-684-2580
Mailing Address - Street 1:1942 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1605
Mailing Address - Country:US
Mailing Address - Phone:718-684-2580
Mailing Address - Fax:718-684-2588
Practice Address - Street 1:1942 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1605
Practice Address - Country:US
Practice Address - Phone:718-684-2580
Practice Address - Fax:718-684-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty