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General NPI Number Information
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NPI Number | 1295557866
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Entity Type | Organization
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Legal Business Name | VITALISTIC WELLNESS INSTITUTE LLC
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 326 1/2 CALDWELL BLVD
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City | NAMPA
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State | ID
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Zip | 83651-1926
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Country | US
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Telephone | 208-242-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 5217 NEZ PERCE RD
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City | CALDWELL
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State | ID
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Zip | 83607-8063
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Country | US
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Telephone | 208-242-4476
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | PAMELA JOAN WATTERSON
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Credential |
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Telephone | 509-961-3849
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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 |
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License Number State |
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