Provider Demographics
NPI:1821818139
Name:VIBRANT VERTEBRAE
Entity type:Organization
Organization Name:VIBRANT VERTEBRAE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-420-9791
Mailing Address - Street 1:500 NE SPANISH RIVER BLVD STE 35
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4517
Mailing Address - Country:US
Mailing Address - Phone:561-969-8284
Mailing Address - Fax:
Practice Address - Street 1:500 NE SPANISH RIVER BLVD STE 35
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4517
Practice Address - Country:US
Practice Address - Phone:561-969-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty