Provider Demographics
NPI:1851070155
Name:VITAL ROOTS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VITAL ROOTS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-963-2609
Mailing Address - Street 1:14300 KENNETH RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66224-3985
Mailing Address - Country:US
Mailing Address - Phone:913-754-7004
Mailing Address - Fax:
Practice Address - Street 1:14300 KENNETH RD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-4598
Practice Address - Country:US
Practice Address - Phone:913-754-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty