Provider Demographics
NPI:1730116559
Name:VITALI, MARIAN L (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:L
Last Name:VITALI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2841
Mailing Address - Country:US
Mailing Address - Phone:860-871-0451
Mailing Address - Fax:860-875-3445
Practice Address - Street 1:68 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2841
Practice Address - Country:US
Practice Address - Phone:860-871-0451
Practice Address - Fax:860-875-3445
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT795111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00411877600Medicaid
U02759Medicare UPIN