Provider Demographics
NPI:1093454076
Name:VITAL CHIROPRACTIC RENEWAL
Entity Type:Organization
Organization Name:VITAL CHIROPRACTIC RENEWAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-736-0326
Mailing Address - Street 1:342 MONTEITH BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-9798
Mailing Address - Country:US
Mailing Address - Phone:828-200-2191
Mailing Address - Fax:
Practice Address - Street 1:1101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3593
Practice Address - Country:US
Practice Address - Phone:828-200-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty