Provider Demographics
NPI:1780490896
Name:VITRUVIAN WELLNESS
Entity type:Organization
Organization Name:VITRUVIAN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-457-7059
Mailing Address - Street 1:3725 HIGHWAY 196 S STE C
Mailing Address - Street 2:
Mailing Address - City:PIPERTON
Mailing Address - State:TN
Mailing Address - Zip Code:38017-5298
Mailing Address - Country:US
Mailing Address - Phone:901-457-7059
Mailing Address - Fax:
Practice Address - Street 1:3725 HIGHWAY 196 S STE C
Practice Address - Street 2:
Practice Address - City:PIPERTON
Practice Address - State:TN
Practice Address - Zip Code:38017-5298
Practice Address - Country:US
Practice Address - Phone:901-457-7059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service