Provider Demographics
NPI:1457667313
Name:VIBRANT HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:VIBRANT HEALTH CENTER, LLC
Other - Org Name:MARISA MIKALS, DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MIKALS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-309-1816
Mailing Address - Street 1:2406 OWENS LANDING WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6551
Mailing Address - Country:US
Mailing Address - Phone:770-309-1816
Mailing Address - Fax:
Practice Address - Street 1:3950 COBB PKWY NW
Practice Address - Street 2:SUITE 401
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9532
Practice Address - Country:US
Practice Address - Phone:770-974-5215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1871619007OtherNPI