Provider Demographics
NPI:1043689110
Name:VITALITY CHIROPRACTIC AND REHABILITATION CENTER
Entity Type:Organization
Organization Name:VITALITY CHIROPRACTIC AND REHABILITATION CENTER
Other - Org Name:SYNERGY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMFELT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-777-0778
Mailing Address - Street 1:807 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-5323
Mailing Address - Country:US
Mailing Address - Phone:302-777-0778
Mailing Address - Fax:302-777-4002
Practice Address - Street 1:807 N UNION STREET
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-777-0778
Practice Address - Fax:302-777-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty