Provider Demographics
NPI:1255807855
Name:VITALITY REHAB & WELLNESS CENTERS
Entity type:Organization
Organization Name:VITALITY REHAB & WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-871-6437
Mailing Address - Street 1:4117 STACY LN
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6193
Mailing Address - Country:US
Mailing Address - Phone:502-802-0569
Mailing Address - Fax:
Practice Address - Street 1:1115 MOUNT ZION RD STE 15
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2241
Practice Address - Country:US
Practice Address - Phone:678-871-6437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174862122OtherNPI