Provider Demographics
NPI:1770355497
Name:VITAL CHIROPRACTIC AND WELLNESS, MANOUKI CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:VITAL CHIROPRACTIC AND WELLNESS, MANOUKI CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANOUKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-631-8009
Mailing Address - Street 1:3400 CAHUENGA BLVD W APT 312
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1584
Mailing Address - Country:US
Mailing Address - Phone:818-631-8009
Mailing Address - Fax:
Practice Address - Street 1:3725 CLIFTON PL
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1614
Practice Address - Country:US
Practice Address - Phone:818-631-8009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty