Healthcare Provider Details

I. General information

NPI: 1891624821
Provider Name (Legal Business Name): VIDA WELLNESS CENTER CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 S COLLEGE AVE STE B
FORT COLLINS CO
80525-5404
US

IV. Provider business mailing address

2111 S COLLEGE AVE STE B
FORT COLLINS CO
80525-5404
US

V. Phone/Fax

Practice location:
  • Phone: 720-297-1086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JAZMIN GENESIS GONZALEZ
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 720-297-1086