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General NPI Number Information
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NPI Number | 1841424371
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Entity Type | Organization
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Legal Business Name | VIBRANT FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 22717 S ELLSWORTH RD SUITE B-101
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-6127
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Country | US
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Telephone | 480-205-6951
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Fax |
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Provider Business Mailing Address
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Address Line | 3959 E LAMBETH PL
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City | QUEEN CREEK
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State | AZ
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Zip | 85240-5126
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Country | US
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Telephone | 480-205-6951
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. NICOLE CHRISTINE GAITANISIOLI
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Credential | D.C.
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Telephone | 480-205-6951
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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 | 7159
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License Number State | AZ
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