Provider Demographics
NPI:1073260659
Name:VIBRANT LIFE LLC
Entity Type:Organization
Organization Name:VIBRANT LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-425-5841
Mailing Address - Street 1:32 BRIDGE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1171
Mailing Address - Country:US
Mailing Address - Phone:516-425-5841
Mailing Address - Fax:
Practice Address - Street 1:32 BRIDGE ST STE 103
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1171
Practice Address - Country:US
Practice Address - Phone:646-706-7366
Practice Address - Fax:646-706-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty