Healthcare Provider Details

I. General information

NPI: 1477709400
Provider Name (Legal Business Name): VITAMIN DOCTOR WELLNESS & CHIROPRACTIC CTR. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 OLD ROUTE 30 STE 3
GREENSBURG PA
15601-7553
US

IV. Provider business mailing address

161 OLD ROUTE 30 STE 3
GREENSBURG PA
15601-7553
US

V. Phone/Fax

Practice location:
  • Phone: 724-850-7550
  • Fax: 724-850-7550
Mailing address:
  • Phone: 724-850-7550
  • Fax: 724-850-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDC4240
License Number StatePA

VIII. Authorized Official

Name: DR. RICHARD K. MARSHALL
Title or Position: PRESIDENT
Credential: DC
Phone: 724-850-7550