MEDICARE: VIBRANT LIFE HEALTH CENTER 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	305S00000X	Point of Service	CH11201	FL

General Provider Information

NPI Number	:	1992110654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT LIFE HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	11798 SAN JOSE BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1836
Country	:	US
Telephone Number	:	904-682-8177
Fax Number	:	904-738-7483

Provider Business Practice Location Address
First Line	:	11798 SAN JOSE BLVD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1836
Country	:	US
Telephone Number	:	904-682-8177
Fax Number	:	904-738-7483

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. JON CLAUDE THOMAS
Credential	:	D.C
Telephone Number	:	904-683-8177

Provider Enumeration Date	:	06/21/2014
Last Update Date	:	08/19/2025

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