MEDICARE: VITALITY HEALTH, 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	3164	SC

General Provider Information

NPI Number	:	1043377369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH, LLC

Provider Business Mailing Address
First Line	:	1567B SAM RITTENBERG BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4248
Country	:	US
Telephone Number	:	843-766-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1567B SAM RITTENBERG BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-4248
Country	:	US
Telephone Number	:	843-766-1969
Fax Number	:	843-766-1906

Authorized Official
Title or Position	:	OWNER
Name	:	RENEE LYNN TOCCO
Credential	:	D.C.
Telephone Number	:	843-766-1969

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	02/25/2008

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