Provider Demographics
NPI:1790936805
Name:VITAL HEAD AND SPINAL CARE, A LICATA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:VITAL HEAD AND SPINAL CARE, A LICATA CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LICATA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-564-8900
Mailing Address - Street 1:131 N EL MOLINO AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-4149
Mailing Address - Country:US
Mailing Address - Phone:626-564-8900
Mailing Address - Fax:626-564-8902
Practice Address - Street 1:131 N EL MOLINO AVE STE 150
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-4149
Practice Address - Country:US
Practice Address - Phone:626-564-8900
Practice Address - Fax:626-564-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty