Healthcare Provider Details

I. General information

NPI: 1093503450
Provider Name (Legal Business Name): VITAL ROOTS CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORTHPOINTE CIR STE 203
SEVEN FIELDS PA
16046-7861
US

IV. Provider business mailing address

200 NORTHPOINTE CIR STE 203
SEVEN FIELDS PA
16046-7861
US

V. Phone/Fax

Practice location:
  • Phone: 614-370-6984
  • Fax:
Mailing address:
  • Phone: 614-370-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ETHAN PATRICK CORMANY
Title or Position: CHIROPRACTOR/MEMBER
Credential: DC
Phone: 614-370-6984