Provider Demographics
NPI:1598957615
Name:VITAL CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:VITAL CHIROPRACTIC CENTER PLLC
Other - Org Name:VITAL CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EWEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MACAULAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-742-7772
Mailing Address - Street 1:15111 MAIN ST STE A103
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9037
Mailing Address - Country:US
Mailing Address - Phone:425-742-7772
Mailing Address - Fax:425-742-7772
Practice Address - Street 1:15111 MAIN ST STE A103
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9037
Practice Address - Country:US
Practice Address - Phone:425-742-7772
Practice Address - Fax:425-742-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003635111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB34557Medicare PIN