Provider Demographics
NPI:1972268985
Name:VITAL BRAIN & SPINE
Entity Type:Organization
Organization Name:VITAL BRAIN & SPINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RADWANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-202-5210
Mailing Address - Street 1:104 CATHERINE LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2522
Mailing Address - Country:US
Mailing Address - Phone:908-202-5210
Mailing Address - Fax:
Practice Address - Street 1:104 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2522
Practice Address - Country:US
Practice Address - Phone:908-202-5210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty