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General NPI Number Information
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NPI Number | 1073050878
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Entity Type | Organization
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Legal Business Name | VIBRANT LIFE FOR KANSAS LLC
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Dates
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Enumeration Date | 01/31/2017
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 4510 W CENTRAL AVE SUITE B
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City | WICHITA
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State | KS
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Zip | 67212-2203
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Country | US
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Telephone | 316-448-3578
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Fax | 316-448-7548
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Provider Business Mailing Address
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Address Line | 4510 W CENTRAL AVE SUITE B
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City | WICHITA
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State | KS
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Zip | 67212-2203
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Country | US
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Telephone | 316-448-3578
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Fax | 316-448-7548
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Authorized Official
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Title or Position | OWNER
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Name | TODD HENRY ECK
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Credential |
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Telephone | 316-448-3578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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