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General NPI Number Information
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NPI Number | 1649941766
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTH AND WELLNESS
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 6400 W COLLEGE DR STE 200
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1786
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Country | US
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Telephone | 708-577-4162
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 W COLLEGE DR STE 200
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1786
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Country | US
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Telephone | 708-577-4162
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RISHI KAPOOR
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Credential | DC
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Telephone | 708-577-4162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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