Provider Demographics
NPI:1043409618
Name:VITAL HEALTH OF THE PALM BEACHES, INC.
Entity Type:Organization
Organization Name:VITAL HEALTH OF THE PALM BEACHES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:ASHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-835-3556
Mailing Address - Street 1:411 7TH ST
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3921
Mailing Address - Country:US
Mailing Address - Phone:561-835-3556
Mailing Address - Fax:561-835-0352
Practice Address - Street 1:411 7TH ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3921
Practice Address - Country:US
Practice Address - Phone:561-835-3556
Practice Address - Fax:561-835-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7797111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7405Medicare PIN