MEDICARE: VITALITY 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	3331	SC

General Provider Information

NPI Number	:	1407019763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	3069 MAYBANK HWY
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4873
Country	:	US
Telephone Number	:	843-628-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3069 MAYBANK HWY
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4873
Country	:	US
Telephone Number	:	843-628-5353
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICOLE BAILEY REITER
Credential	:	DC
Telephone Number	:	843-628-5353

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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