Provider Demographics
NPI:1891994794
Name:VESTA, PLC
Entity Type:Organization
Organization Name:VESTA, PLC
Other - Org Name:BACK IN BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-985-3300
Mailing Address - Street 1:5247 SHELBURNE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7018
Mailing Address - Country:US
Mailing Address - Phone:802-985-3300
Mailing Address - Fax:802-735-0454
Practice Address - Street 1:5247 SHELBURNE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7018
Practice Address - Country:US
Practice Address - Phone:802-985-3300
Practice Address - Fax:802-735-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002856Medicare PIN