Healthcare Provider Details

I. General information

NPI: 1013505932
Provider Name (Legal Business Name): VITALITY CHIROPRACTIC & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4314 OLD WILLIAM PENN HWY STE 103
MONROEVILLE PA
15146-1455
US

IV. Provider business mailing address

4314 OLD WILLIAM PENN HWY STE 103
MONROEVILLE PA
15146-1455
US

V. Phone/Fax

Practice location:
  • Phone: 412-779-2167
  • Fax:
Mailing address:
  • Phone: 724-237-5025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAITLIN JORDAN
Title or Position: OPERATING MANAGER, DOCTOR
Credential: DC
Phone: 724-237-5025