Provider Demographics
NPI:1407889793
Name:QUANTUM VITALITY CENTRES, INC.
Entity Type:Organization
Organization Name:QUANTUM VITALITY CENTRES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:SZAKACS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:813-312-3526
Mailing Address - Street 1:2905 TRAVERSE TRL
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-2017
Mailing Address - Country:US
Mailing Address - Phone:352-430-3399
Mailing Address - Fax:888-241-0433
Practice Address - Street 1:2905 TRAVERSE TRL
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2017
Practice Address - Country:US
Practice Address - Phone:352-430-3399
Practice Address - Fax:888-241-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6989111N00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77316OtherBLUE CROSS & BLUE SHIELD
FL7063360001Medicare NSC
FL1407889793Medicare PIN