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General NPI Number Information
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NPI Number | 1750935920
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Entity Type | Organization
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Legal Business Name | VIBRANT LIFE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 1956 S KOELLER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6153
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Country | US
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Telephone | 920-385-4073
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Fax | 920-385-1594
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Provider Business Mailing Address
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Address Line | 1956 S KOELLER ST
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City | OSHKOSH
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State | WI
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Zip | 54902-6153
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Country | US
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Telephone | 920-385-4073
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Fax | 920-385-1594
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHRISTOPHE RICHARD PURTELL
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Credential | DC
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Telephone | 920-379-2639
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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 |
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License Number State |
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