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General NPI Number Information
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NPI Number | 1770907107
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Entity Type | Organization
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Legal Business Name | VITALITY CHIROPRACTIC FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 2650 BAHIA VISTA ST STE 304
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City | SARASOTA
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State | FL
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Zip | 34239-2634
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Country | US
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Telephone | 941-777-3375
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Fax | 941-451-2011
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Provider Business Mailing Address
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Address Line | 1379 MCANSH SQ
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City | SARASOTA
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State | FL
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Zip | 34236-5620
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Country | US
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Telephone | 941-258-8462
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA RENEE LEIGH
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Credential | D.C.
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Telephone | 941-258-8462
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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 | CH11103
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License Number State | FL
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