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General NPI Number Information
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NPI Number | 1417149493
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Entity Type | Organization
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Legal Business Name | BELLA VITA CHIROPRACTIC WELLNESS PC
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 610 EASTBURY DR. SUITE 3
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City | IOWA CITY
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State | IA
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Zip | 52245
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Country | US
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Telephone | 319-887-6992
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Fax | 319-887-6983
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Provider Business Mailing Address
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Address Line | 610 EASTBURY DR. SUITE 3
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City | IOWA CITY
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State | IA
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Zip | 52245
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Country | US
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Telephone | 319-887-6992
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Fax | 319-887-6983
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORDAN MICHAEL DEGRAZIA
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Credential | DC
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Telephone | 319-887-6992
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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 | 06528
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License Number State | IA
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