Provider Demographics
NPI:1841424371
Name:VIBRANT FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:VIBRANT FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:GAITANISIOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-205-6951
Mailing Address - Street 1:3959 E LAMBETH PL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85240-5126
Mailing Address - Country:US
Mailing Address - Phone:480-205-6951
Mailing Address - Fax:
Practice Address - Street 1:22717 S ELLSWORTH RD
Practice Address - Street 2:SUITE B-101
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85242-6127
Practice Address - Country:US
Practice Address - Phone:480-205-6951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty