Provider Demographics
NPI:1306726658
Name:VITAL RADIANCE WELLNESS, LLC
Entity type:Organization
Organization Name:VITAL RADIANCE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LUCZYWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-974-3500
Mailing Address - Street 1:29 W SMITH ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3582
Mailing Address - Country:US
Mailing Address - Phone:407-974-3500
Mailing Address - Fax:
Practice Address - Street 1:29 W SMITH ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3582
Practice Address - Country:US
Practice Address - Phone:407-974-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-06
Last Update Date:2025-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Multi-Specialty