Provider Demographics
NPI:1710497193
Name:VIBRANT SOL CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:VIBRANT SOL CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BRE
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-604-7368
Mailing Address - Street 1:9300 DRAPER LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-9311
Mailing Address - Country:US
Mailing Address - Phone:405-604-7368
Mailing Address - Fax:
Practice Address - Street 1:9107 SE 29TH ST STE B
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-7163
Practice Address - Country:US
Practice Address - Phone:405-604-7368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty