Healthcare Provider Details

I. General information

NPI: 1164883971
Provider Name (Legal Business Name): VITA SANA CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20241 W VALLEY BLVD STE B
TEHACHAPI CA
93561-8746
US

IV. Provider business mailing address

20241 W VALLEY BLVD STE B
TEHACHAPI CA
93561-8746
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-1473
  • Fax: 661-823-1475
Mailing address:
  • Phone: 661-823-1473
  • Fax: 661-823-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC022172
License Number StateCA

VIII. Authorized Official

Name: DANIELLE SOTTILE
Title or Position: CEO
Credential: D.C.
Phone: 661-823-1473