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General NPI Number Information
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NPI Number | 1710497193
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Entity Type | Organization
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Legal Business Name | VIBRANT SOL CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 9107 SE 29TH ST STE B
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City | MIDWEST CITY
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State | OK
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Zip | 73130-7163
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Country | US
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Telephone | 405-604-7368
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Fax |
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Provider Business Mailing Address
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Address Line | 9300 DRAPER LN
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City | OKLAHOMA CITY
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State | OK
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Zip | 73165-9311
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Country | US
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Telephone | 405-604-7368
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JESSICA BRE SOLIS
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Credential | DC
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Telephone | 405-604-7368
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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 | 4248
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License Number State | OK
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