=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902379746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE VITALITY CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2019
-----------------------------------------------------
Last Update Date | 01/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7216 WELLINGTON DR STE 3
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-5931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-588-5734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7216 WELLINGTON DR STE 3
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37919-5931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-588-5734
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CORY THOMAS O'LEAR-ZEBROSKI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 865-789-5299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------