Provider Demographics
NPI:1427384478
Name:VIBRANT HEALTH FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VIBRANT HEALTH FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:HERDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-446-9600
Mailing Address - Street 1:4080 TOWER STREET
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:ST BONIFACIUS
Mailing Address - State:MN
Mailing Address - Zip Code:55375
Mailing Address - Country:US
Mailing Address - Phone:952-446-9600
Mailing Address - Fax:952-446-9603
Practice Address - Street 1:4080 TOWER STREET
Practice Address - Street 2:SUITE 1080
Practice Address - City:ST BONIFACIUS
Practice Address - State:MN
Practice Address - Zip Code:55375
Practice Address - Country:US
Practice Address - Phone:952-446-9600
Practice Address - Fax:952-446-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty