Provider Demographics
NPI:1346840733
Name:VITALIFE CHIROPRACTIC OF PAYNESVILLE, PLLC
Entity Type:Organization
Organization Name:VITALIFE CHIROPRACTIC OF PAYNESVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:STENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-248-0040
Mailing Address - Street 1:208 W JAMES ST
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-1219
Mailing Address - Country:US
Mailing Address - Phone:320-243-7412
Mailing Address - Fax:
Practice Address - Street 1:208 W JAMES ST
Practice Address - Street 2:
Practice Address - City:PAYNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56362-1219
Practice Address - Country:US
Practice Address - Phone:320-243-7412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty