Healthcare Provider Details

I. General information

NPI: 1467054262
Provider Name (Legal Business Name): VITALITY HEALTH REGENERATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 N MAIN STREET, STE. 1
THAYNE WY
83127
US

IV. Provider business mailing address

PO BOX 1466
THAYNE WY
83127-1466
US

V. Phone/Fax

Practice location:
  • Phone: 307-883-4000
  • Fax: 307-883-4001
Mailing address:
  • Phone: 307-883-4000
  • Fax: 307-883-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT M SESSIONS
Title or Position: DOCTOR AND OWNER
Credential: DC, CCSP
Phone: 307-883-4000