Provider Demographics
NPI:1952840498
Name:VITA CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:VITA CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-242-2935
Mailing Address - Street 1:7850 ULMERTON RD
Mailing Address - Street 2:1-B
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4064
Mailing Address - Country:US
Mailing Address - Phone:727-242-2935
Mailing Address - Fax:727-666-7689
Practice Address - Street 1:7850 ULMERTON RD
Practice Address - Street 2:1-B
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4064
Practice Address - Country:US
Practice Address - Phone:727-242-2935
Practice Address - Fax:727-666-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11333111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty