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General NPI Number Information
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NPI Number | 1992110654
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Entity Type | Organization
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Legal Business Name | VIBRANT LIFE HEALTH CENTER LLC
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Dates
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Enumeration Date | 06/21/2014
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 11798 SAN JOSE BLVD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1836
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Country | US
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Telephone | 904-682-8177
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Fax | 904-738-7483
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Provider Business Mailing Address
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Address Line | 11798 SAN JOSE BLVD STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1836
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Country | US
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Telephone | 904-682-8177
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Fax | 904-738-7483
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. JON CLAUDE THOMAS
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Credential | D.C
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Telephone | 904-683-8177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | CH11201
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License Number State | FL
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