Provider Demographics
NPI:1649676735
Name:VITAL FORCE CHIROPRACTIC PC
Entity type:Organization
Organization Name:VITAL FORCE CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-596-4070
Mailing Address - Street 1:10028 MANCHESTER RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-1831
Mailing Address - Country:US
Mailing Address - Phone:314-596-4070
Mailing Address - Fax:314-596-4075
Practice Address - Street 1:10028 MANCHESTER RD
Practice Address - Street 2:SUITE 209
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-1831
Practice Address - Country:US
Practice Address - Phone:314-596-4070
Practice Address - Fax:314-596-4075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008000933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty