Healthcare Provider Details

I. General information

NPI: 1043689110
Provider Name (Legal Business Name): VITALITY CHIROPRACTIC AND REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N UNION STREET
WILMINGTON DE
19805
US

IV. Provider business mailing address

807 N UNION ST
WILMINGTON DE
19805-5323
US

V. Phone/Fax

Practice location:
  • Phone: 302-777-0778
  • Fax: 302-777-4002
Mailing address:
  • Phone: 302-777-0778
  • Fax: 302-777-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberF1-0000911
License Number StateDE

VIII. Authorized Official

Name: CRAIG HUMFELT
Title or Position: CHIROPRACTOR
Credential: D.C
Phone: 302-777-0778