Provider Demographics
NPI:1245911700
Name:VITALITY CHIROPRACTIC
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:TRAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-819-1060
Mailing Address - Street 1:1122 MALCOLM AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3506
Mailing Address - Country:US
Mailing Address - Phone:870-523-2225
Mailing Address - Fax:870-523-9000
Practice Address - Street 1:1411 MARKETPLACE DR STE B
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5232
Practice Address - Country:US
Practice Address - Phone:870-523-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty