Healthcare Provider Details

I. General information

NPI: 1245911700
Provider Name (Legal Business Name): VITALITY CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 MARKETPLACE DR STE B
JONESBORO AR
72401-5232
US

IV. Provider business mailing address

1122 MALCOLM AVE
NEWPORT AR
72112-3506
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-2225
  • Fax:
Mailing address:
  • Phone: 870-523-2225
  • Fax: 870-523-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MISTY DAWN TRAMEL
Title or Position: PRESIDENT
Credential: DC
Phone: 870-819-1060