Provider Demographics
NPI:1740096692
Name:VIVID QI, PLLC
Entity type:Organization
Organization Name:VIVID QI, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:305-676-2789
Mailing Address - Street 1:7601 E TREASURE DR APT 1716
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4366
Mailing Address - Country:US
Mailing Address - Phone:206-859-1691
Mailing Address - Fax:
Practice Address - Street 1:1441 BRICKELL AVE FL 4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-3425
Practice Address - Country:US
Practice Address - Phone:305-676-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty