Provider Demographics
NPI:1649941766
Name:VITALITY HEALTH AND WELLNESS
Entity type:Organization
Organization Name:VITALITY HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPOOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:708-577-4162
Mailing Address - Street 1:6400 W COLLEGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1786
Mailing Address - Country:US
Mailing Address - Phone:708-577-4162
Mailing Address - Fax:
Practice Address - Street 1:6400 W COLLEGE DR STE 200
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1786
Practice Address - Country:US
Practice Address - Phone:708-577-4162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty