Provider Demographics
NPI:1508132218
Name:VITA CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:VITA CHIROPRACTIC, PLLC
Other - Org Name:VITA CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:469-554-8482
Mailing Address - Street 1:5646 MILTON ST
Mailing Address - Street 2:SUITE 608A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3907
Mailing Address - Country:US
Mailing Address - Phone:469-554-8482
Mailing Address - Fax:
Practice Address - Street 1:5646 MILTON ST
Practice Address - Street 2:SUITE 608A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-3907
Practice Address - Country:US
Practice Address - Phone:469-554-8482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12040111N00000X, 111NS0005X
TX12039111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty