Healthcare Provider Details

I. General information

NPI: 1558329102
Provider Name (Legal Business Name): MICHAEL JEROME VAHILA MT RAC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4643 18TH ST NW
CANTON OH
44708-2105
US

IV. Provider business mailing address

4643 18TH ST NW
CANTON OH
44708-2105
US

V. Phone/Fax

Practice location:
  • Phone: 330-477-0777
  • Fax: 330-477-0777
Mailing address:
  • Phone: 330-477-0777
  • Fax: 330-477-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number106
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: