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NPI Code Detail

MEDICARE: VITALITY HEALTH, LLC

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
1111N00000XChiropractor3164SC

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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Directions to “VITALITY HEALTH, LLC ” Practice Location

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