MEDICARE: VITALITY HEALTH AND WELLNESS

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
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1649941766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	6400 W COLLEGE DR STE 200
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1786
Country	:	US
Telephone Number	:	708-577-4162
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 W COLLEGE DR STE 200
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1786
Country	:	US
Telephone Number	:	708-577-4162
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RISHI KAPOOR
Credential	:	DC
Telephone Number	:	708-577-4162

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	04/06/2022

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Directions to “VITALITY HEALTH AND WELLNESS ” Practice Location

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