Provider Demographics
NPI:1275568164
Name:VITAMUNDO LLC
Entity Type:Organization
Organization Name:VITAMUNDO LLC
Other - Org Name:LIVE FREE CHIROPRACTIC/VIDA LIBRE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-960-3160
Mailing Address - Street 1:13905 CARROLLWOOD VILLAGE RUN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2746
Mailing Address - Country:US
Mailing Address - Phone:813-960-3160
Mailing Address - Fax:813-960-0160
Practice Address - Street 1:13905 CARROLLWOOD VILLAGE RUN
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2746
Practice Address - Country:US
Practice Address - Phone:813-960-3160
Practice Address - Fax:813-960-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty