Provider Demographics
NPI:1760671242
Name:VITAL CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:VITAL CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-848-6755
Mailing Address - Street 1:1509C RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-2495
Mailing Address - Country:US
Mailing Address - Phone:360-848-6755
Mailing Address - Fax:360-848-7806
Practice Address - Street 1:1509C RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-2495
Practice Address - Country:US
Practice Address - Phone:360-848-6755
Practice Address - Fax:360-848-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8851509Medicare PIN