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General NPI Number Information
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NPI Number | 1770355497
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Entity Type | Organization
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Legal Business Name | VITAL CHIROPRACTIC AND WELLNESS, MANOUKI CHIROPRACTIC CORPORATION
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 3725 CLIFTON PL
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City | MONTROSE
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State | CA
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Zip | 91020-1614
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Country | US
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Telephone | 818-631-8009
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 CAHUENGA BLVD W APT 312
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City | LOS ANGELES
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State | CA
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Zip | 90068-1584
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Country | US
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Telephone | 818-631-8009
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MEHER MANOUKI
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Credential | D.C.
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Telephone | 818-631-8009
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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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