Provider Demographics
NPI:1922362391
Name:VITALISTIC HEALING ARTS CENTER INC.
Entity Type:Organization
Organization Name:VITALISTIC HEALING ARTS CENTER INC.
Other - Org Name:MICHAEL JAMES WHELAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER OF THE BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHELAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-581-5231
Mailing Address - Street 1:25431 CABOT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5527
Mailing Address - Country:US
Mailing Address - Phone:949-581-5231
Mailing Address - Fax:949-215-8928
Practice Address - Street 1:25431 CABOT RD STE 205
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5527
Practice Address - Country:US
Practice Address - Phone:949-581-5231
Practice Address - Fax:949-215-8928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ991AMedicare UPIN