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General NPI Number Information
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NPI Number | 1922807304
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Entity Type | Organization
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Legal Business Name | BASE VITALITY PLLC
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Dates
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Enumeration Date | 03/10/2025
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 103 PONDEROSA LN
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City | KALISPELL
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State | MT
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Zip | 59901-6833
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Country | US
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Telephone | 406-220-5058
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Fax |
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Provider Business Mailing Address
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Address Line | 103 PONDEROSA LN
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City | KALISPELL
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State | MT
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Zip | 59901-6833
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Country | US
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Telephone | 406-220-5058
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | ANDREA EMDE
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Credential | ND, DC
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Telephone | 406-220-5058
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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