=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053478628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITALITY STUDIOS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2007
-----------------------------------------------------
Last Update Date | 04/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5072 WEST PLANO PARKWAY SUITE 170
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-248-7488
-----------------------------------------------------
Fax | 972-250-1924
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 260172
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-248-7488
-----------------------------------------------------
Fax | 972-250-1924
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | WALTER JOE FORD JR.
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 972-248-7488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------