Provider Demographics
NPI:1457884314
Name:VITALITY CHIROPRACTIC & ACUPUNCTURE LLC
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:STENSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-236-5531
Mailing Address - Street 1:1051 MADISON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6143
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1051 MADISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6143
Practice Address - Country:US
Practice Address - Phone:507-236-5531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty