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General NPI Number Information
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NPI Number | 1891916938
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Entity Type | Organization
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Legal Business Name | VITALITY CHIROPRACTIC CLINIC, PLLC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 410 W SPRUCE ST
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City | MISSOULA
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State | MT
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Zip | 59802-4106
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Country | US
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Telephone | 406-549-0119
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Fax | 406-549-0946
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Provider Business Mailing Address
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Address Line | 410 W SPRUCE ST
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City | MISSOULA
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State | MT
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Zip | 59802-4106
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Country | US
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Telephone | 406-549-0119
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Fax | 406-549-0946
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHELBY N SMITH
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Credential | D.O.
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Telephone | 406-549-0119
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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 | 1123
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License Number State | MT
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