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NPI Code Detail

MEDICARE: BASE VITALITY PLLC

MEDICARE: BASE VITALITY PLLC
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
1111N00000XChiropractor
2261Q00000XClinic/Center

General Provider Information

NPI Number : 1114727237
Entity Type Code : Organization
Provider Name (Legal Business Name) : BASE VITALITY PLLC
Provider Business Mailing Address
First Line : 103 PONDEROSA LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-6833
Country : US
Telephone Number : 406-220-5058
Fax Number :
Provider Business Practice Location Address
First Line : 103 PONDEROSA LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-6833
Country : US
Telephone Number : 406-220-5058
Fax Number :
Authorized Official
Title or Position : PHYSICIAN
Name : ANDREA L EMDE
Credential :
Telephone Number : 406-220-5058
Provider Enumeration Date : 03/17/2025
Last Update Date : 02/02/2026

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