MEDICARE: VITALISTIC WAVE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1003761859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALISTIC WAVE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1600 PARKWOOD CIR SE STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2147
Country	:	US
Telephone Number	:	404-908-2150
Fax Number	:	770-264-3652

Provider Business Practice Location Address
First Line	:	1600 PARKWOOD CIR SE STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2147
Country	:	US
Telephone Number	:	404-908-2150
Fax Number	:	770-264-3652

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICARDO ALBINO DIAZ
Credential	:	DC
Telephone Number	:	787-585-9475

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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