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General NPI Number Information
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NPI Number | 1780490896
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Entity Type | Organization
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Legal Business Name | VITRUVIAN WELLNESS
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 3725 HIGHWAY 196 S STE C
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City | PIPERTON
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State | TN
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Zip | 38017-5298
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Country | US
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Telephone | 901-457-7059
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 HIGHWAY 196 S STE C
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City | PIPERTON
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State | TN
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Zip | 38017-5298
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Country | US
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Telephone | 901-457-7059
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ADAM THOMAS HAYDEN
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Credential | D.C.
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Telephone | 901-457-7059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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