Provider Demographics
NPI:1508223637
Name:VITAL CHIROPRACTIC & WELLNESS PLLC
Entity Type:Organization
Organization Name:VITAL CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:FAMILY FIRST CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-963-9469
Mailing Address - Street 1:1221 W BEN WHITE BLVD
Mailing Address - Street 2:STE. 111A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7192
Mailing Address - Country:US
Mailing Address - Phone:737-222-6014
Mailing Address - Fax:737-222-5986
Practice Address - Street 1:1221 W BEN WHITE BLVD
Practice Address - Street 2:STE. 111A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7192
Practice Address - Country:US
Practice Address - Phone:737-222-6014
Practice Address - Fax:737-222-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty