Provider Demographics
NPI:1104215342
Name:PURE HEALTH AND VITALITY INC.
Entity Type:Organization
Organization Name:PURE HEALTH AND VITALITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:BRESSY
Authorized Official - Last Name:CASHMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCN
Authorized Official - Phone:847-784-9156
Mailing Address - Street 1:666 DUNDEE RD
Mailing Address - Street 2:1903
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2727
Mailing Address - Country:US
Mailing Address - Phone:847-784-9156
Mailing Address - Fax:847-278-5588
Practice Address - Street 1:666 DUNDEE RD
Practice Address - Street 2:1903
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2727
Practice Address - Country:US
Practice Address - Phone:847-784-9156
Practice Address - Fax:847-278-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010095111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty