Provider Demographics
NPI:1952090318
Name:VITA CHIROPRACTIC & WELLNESS,
Entity type:Organization
Organization Name:VITA CHIROPRACTIC & WELLNESS,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BAHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-978-1870
Mailing Address - Street 1:14429 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50323-2032
Mailing Address - Country:US
Mailing Address - Phone:641-330-2267
Mailing Address - Fax:
Practice Address - Street 1:450 SE UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8121
Practice Address - Country:US
Practice Address - Phone:575-978-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1669739504OtherPROVIDER NPI