MEDICARE: VITA, A CHIROPRACTIC AND WELLNESS CTR INC

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	:	1033254727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITA, A CHIROPRACTIC AND WELLNESS CTR INC

Provider Business Mailing Address
First Line	:	4674 RIDGE RD
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3317
Country	:	US
Telephone Number	:	216-749-7888
Fax Number	:	216-749-6660

Provider Business Practice Location Address
First Line	:	4674 RIDGE RD
Second Line	:
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3317
Country	:	US
Telephone Number	:	216-749-7888
Fax Number	:	216-749-6660

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	LINDA L GROVES
Credential	:	CPC, CPCH, MBP, CMA
Telephone Number	:	440-352-6132

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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