Provider Demographics
NPI:1790255974
Name:VITAL HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:VITAL HEALTH CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-778-0029
Mailing Address - Street 1:6340 SECURITY BLVD # A-20
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5173
Mailing Address - Country:US
Mailing Address - Phone:301-778-0029
Mailing Address - Fax:301-637-7828
Practice Address - Street 1:6340 SECURITY BLVD # A-20
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5173
Practice Address - Country:US
Practice Address - Phone:301-778-0029
Practice Address - Fax:301-637-7828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-29
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty