Provider Demographics
NPI:1508582628
Name:VITAL NUTRITION & CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VITAL NUTRITION & CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLAFFKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-479-4893
Mailing Address - Street 1:809 S LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3715
Mailing Address - Country:US
Mailing Address - Phone:803-399-8104
Mailing Address - Fax:
Practice Address - Street 1:809 S LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3715
Practice Address - Country:US
Practice Address - Phone:803-399-8104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty