Provider Demographics
NPI:1255711917
Name:VITALITY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:VITALITY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SALCIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-379-3653
Mailing Address - Street 1:99 LONG CT
Mailing Address - Street 2:#103
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 LONG CT
Practice Address - Street 2:#103
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6066
Practice Address - Country:US
Practice Address - Phone:805-379-3653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223013OtherMEDICARE ID