Provider Demographics
NPI:1710323167
Name:VILLAGE HEALTHWORKS CHIRO, LLC
Entity Type:Organization
Organization Name:VILLAGE HEALTHWORKS CHIRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VLADYKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-645-9244
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:DORSET
Mailing Address - State:VT
Mailing Address - Zip Code:05251-0247
Mailing Address - Country:US
Mailing Address - Phone:802-645-9244
Mailing Address - Fax:802-645-9243
Practice Address - Street 1:87 MEADOW LN
Practice Address - Street 2:
Practice Address - City:DORSET
Practice Address - State:VT
Practice Address - Zip Code:05251-9463
Practice Address - Country:US
Practice Address - Phone:802-645-9244
Practice Address - Fax:802-645-9243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0001103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty