Provider Demographics
NPI:1205461365
Name:VIBRANT LIFE HEALTH & WELLNESS
Entity type:Organization
Organization Name:VIBRANT LIFE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:STITHEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-475-5294
Mailing Address - Street 1:7633 E BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3290
Mailing Address - Country:US
Mailing Address - Phone:423-763-7226
Mailing Address - Fax:
Practice Address - Street 1:7633 E BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3290
Practice Address - Country:US
Practice Address - Phone:423-763-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies