Provider Demographics
NPI:1902382310
Name:COMPLETE VITALITY
Entity Type:Organization
Organization Name:COMPLETE VITALITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:VANCHIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-374-2774
Mailing Address - Street 1:3325 N UNIVERSITY AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-6615
Mailing Address - Country:US
Mailing Address - Phone:801-374-2774
Mailing Address - Fax:801-374-2775
Practice Address - Street 1:3325 N UNIVERSITY AVE STE 125
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6615
Practice Address - Country:US
Practice Address - Phone:801-374-2774
Practice Address - Fax:801-374-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9648109-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1972962173OtherNPI