Provider Demographics
NPI:1760668651
Name:VITAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:VITAL HEALTH CENTER, INC.
Other - Org Name:VITAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEME
Authorized Official - Suffix:III
Authorized Official - Credentials:LAC, DIPL AC
Authorized Official - Phone:503-481-0283
Mailing Address - Street 1:1417 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4225
Mailing Address - Country:US
Mailing Address - Phone:503-481-0283
Mailing Address - Fax:503-536-6590
Practice Address - Street 1:1417 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4225
Practice Address - Country:US
Practice Address - Phone:503-481-0283
Practice Address - Fax:503-536-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01143171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty