Healthcare Provider Details

I. General information

NPI: 1922695220
Provider Name (Legal Business Name): VITALITY HOLISTIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8131 WORNALL RD
KANSAS CITY MO
64114-5815
US

IV. Provider business mailing address

4310 W 77TH TER
PRAIRIE VILLAGE KS
66208-4348
US

V. Phone/Fax

Practice location:
  • Phone: 917-855-1579
  • Fax:
Mailing address:
  • Phone: 917-855-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET LYNNE LEE
Title or Position: OWNER, ACUPUNCTURIST
Credential: DACM, LAC
Phone: 917-855-1579