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General NPI Number Information
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NPI Number | 1841169521
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Entity Type | Organization
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Legal Business Name | KJ VITAL HOLDINGS INC
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Dates
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Enumeration Date | 11/01/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 7918 MITCHELL RD
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-2218
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Country | US
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Telephone | 952-222-0789
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Fax |
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Provider Business Mailing Address
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Address Line | 215 S ELM ST
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City | BELLE PLAINE
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State | MN
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Zip | 56011-2107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JOSEPH VANDERMARK
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Credential |
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Telephone | 612-888-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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