Provider Demographics
NPI:1801067095
Name:VITALE, ANTHONY THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:THOMAS
Last Name:VITALE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:KY
Mailing Address - Zip Code:42211-9104
Mailing Address - Country:US
Mailing Address - Phone:270-206-9190
Mailing Address - Fax:
Practice Address - Street 1:347 MAIN ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:KY
Practice Address - Zip Code:42211-9104
Practice Address - Country:US
Practice Address - Phone:270-206-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor