MEDICARE: VITALITY CHIROPRACTIC CENTER, 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	261QH0100X	Health Service Clinic/Center	CH00003453	WA

General Provider Information

NPI Number	:	1689871659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY CHIROPRACTIC CENTER, INC.

Provider Business Mailing Address
First Line	:	410 BELLEVUE WAY SE STE 202
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6649
Country	:	US
Telephone Number	:	425-378-1800
Fax Number	:	425-462-1802

Provider Business Practice Location Address
First Line	:	410 BELLEVUE WAY SE STE 202
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6649
Country	:	US
Telephone Number	:	425-378-1800
Fax Number	:	425-462-1802

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. COREY TAYLOR EBBIN
Credential	:	D.C.
Telephone Number	:	425-378-1800

Provider Enumeration Date	:	07/02/2007
Last Update Date	:	10/01/2014

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