Provider Demographics
NPI:1619365996
Name:VITAL LIFE CHIROPRACTIC
Entity Type:Organization
Organization Name:VITAL LIFE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAK
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-791-3222
Mailing Address - Street 1:PO BOX 3685
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3685
Mailing Address - Country:US
Mailing Address - Phone:605-791-3222
Mailing Address - Fax:
Practice Address - Street 1:811 DISK DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7803
Practice Address - Country:US
Practice Address - Phone:605-791-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty