Provider Demographics
NPI:1578846770
Name:VITALITY CHIROPRACTIC WELLNESS INC
Entity Type:Organization
Organization Name:VITALITY CHIROPRACTIC WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDLICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:562-598-9801
Mailing Address - Street 1:10900 LOS ALAMITOS BLVD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2354
Mailing Address - Country:US
Mailing Address - Phone:562-598-9801
Mailing Address - Fax:714-677-1791
Practice Address - Street 1:10900 LOS ALAMITOS BLVD
Practice Address - Street 2:SUITE 141
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2354
Practice Address - Country:US
Practice Address - Phone:562-598-9801
Practice Address - Fax:714-677-1791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty