Healthcare Provider Details

I. General information

NPI: 1689871659
Provider Name (Legal Business Name): VITALITY CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 BELLEVUE WAY SE STE 202
BELLEVUE WA
98004-6649
US

IV. Provider business mailing address

410 BELLEVUE WAY SE STE 202
BELLEVUE WA
98004-6649
US

V. Phone/Fax

Practice location:
  • Phone: 425-378-1800
  • Fax: 425-462-1802
Mailing address:
  • Phone: 425-378-1800
  • Fax: 425-462-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberCH00003453
License Number StateWA

VIII. Authorized Official

Name: DR. COREY TAYLOR EBBIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 425-378-1800