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NPI Code Detail

MEDICARE: VITALITY CHIROPRACTIC, LLC

MEDICARE: VITALITY CHIROPRACTIC, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor3331SC

General Provider Information

NPI Number : 1407019763
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITALITY CHIROPRACTIC, LLC
Provider Business Mailing Address
First Line : 3069 MAYBANK HWY
Second Line :
City : JOHNS ISLAND
State : SC
Zip : 29455-4873
Country : US
Telephone Number : 843-628-5353
Fax Number :
Provider Business Practice Location Address
First Line : 3069 MAYBANK HWY
Second Line :
City : JOHNS ISLAND
State : SC
Zip : 29455-4873
Country : US
Telephone Number : 843-628-5353
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. NICOLE BAILEY REITER
Credential : DC
Telephone Number : 843-628-5353
Provider Enumeration Date : 07/08/2008
Last Update Date : 07/08/2008

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Directions to “VITALITY CHIROPRACTIC, LLC ” Practice Location

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