Healthcare Provider Details

I. General information

NPI: 1346178951
Provider Name (Legal Business Name): VITALCORE WELLNESS & DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N PARHAM RD STE 104
RICHMOND VA
23294-4412
US

IV. Provider business mailing address

2821 N PARHAM RD STE 104
RICHMOND VA
23294-4412
US

V. Phone/Fax

Practice location:
  • Phone: 686-208-8491
  • Fax:
Mailing address:
  • Phone: 686-208-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SIMONE KING
Title or Position: CEO
Credential:
Phone: 686-208-8491