Provider Demographics
NPI:1790325207
Name:VIDA CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:VIDA CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PLYMELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-468-5845
Mailing Address - Street 1:7319 N JOHN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4890
Mailing Address - Country:US
Mailing Address - Phone:503-468-5845
Mailing Address - Fax:
Practice Address - Street 1:7319 N JOHN AVE STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4890
Practice Address - Country:US
Practice Address - Phone:503-468-5845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty