=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750629507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL HEALTH INTEGRATIVE CHIROPRACTIC CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2013
-----------------------------------------------------
Last Update Date | 04/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 W WASHINGTON ST 1704
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-818-6272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 W WASHINGTON ST 1704
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60602-2801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-818-6272
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC PHYSICIAN
-----------------------------------------------------
Name | ERINA KASTRATI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 773-818-6272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038012213
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------