Healthcare Provider Details

I. General information

NPI: 1558502377
Provider Name (Legal Business Name): VIBRANCE CHIROPRACTIC & WELLNESS CENTER, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 LAUREL LANE
CARY IL
60013-3205
US

IV. Provider business mailing address

PO BOX 453
CARY IL
60013-3205
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-6066
  • Fax: 866-837-6099
Mailing address:
  • Phone: 847-658-6066
  • Fax: 866-837-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. GINA MOSKALIK
Title or Position: PRESIDENT/CHIROPRACTOR
Credential: DC
Phone: 847-658-6066