MEDICARE: VITAL CHIROPRACTIC 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
1	111N00000X	Chiropractor		WA

General Provider Information

NPI Number	:	1760671242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	1509C RIVERSIDE DR
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2495
Country	:	US
Telephone Number	:	360-848-6755
Fax Number	:	360-848-7806

Provider Business Practice Location Address
First Line	:	1509C RIVERSIDE DR
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-2495
Country	:	US
Telephone Number	:	360-848-6755
Fax Number	:	360-848-7806

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT J. SCHMITT
Credential	:	D.C.
Telephone Number	:	360-848-6755

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	03/28/2008

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