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General NPI Number Information
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NPI Number | 1255721189
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Entity Type | Organization
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Legal Business Name | VITALITY CHIRO PC
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 214 E STAPLES ST
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City | ARTHUR
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State | NE
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Zip | 69121-8410
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Country | US
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Telephone | 308-284-0838
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Fax | 308-284-0848
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Provider Business Mailing Address
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Address Line | PO BOX 96
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City | OGALLALA
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State | NE
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Zip | 69153-0096
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Country | US
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Telephone | 308-284-0838
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Fax | 308-284-0848
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. NICOLAS J FANNING
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Credential | D.C., M.S.
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Telephone | 308-284-0838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1567
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License Number State | NE
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