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General NPI Number Information
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NPI Number | 1538943089
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Entity Type | Organization
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Legal Business Name | VITALITY TRAVELING LABORATORY LLC
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 1 E ERIE ST STE 525-4357
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 773-226-2149
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Fax | 219-803-2124
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Provider Business Mailing Address
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Address Line | 1 E ERIE ST STE 525-4357
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City | CHICAGO
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State | IL
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Zip | 60611-2740
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Country | US
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Telephone | 773-226-2149
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Fax | 219-803-2124
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Authorized Official
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Title or Position | PHLEBOTOMIST, OWNER
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Name | RACHELE' JACQUES
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Credential | M.A, PHLEBOTOMIST
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Telephone | 219-742-5233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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