Healthcare Provider Details

I. General information

NPI: 1770148363
Provider Name (Legal Business Name): VITALITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2824 GRAND AVE STE 102
EVERETT WA
98201-3482
US

IV. Provider business mailing address

2824 GRAND AVE STE 102
EVERETT WA
98201-3482
US

V. Phone/Fax

Practice location:
  • Phone: 425-257-0177
  • Fax:
Mailing address:
  • Phone: 425-257-0177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: RHEA BUCASAS
Title or Position: OWNER
Credential: D.C.
Phone: 425-257-0177