Provider Demographics
NPI:1447062393
Name:VITALITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ BENITEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:939-401-3861
Mailing Address - Street 1:335 CENTRAL STATE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-0105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5637 W 56TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1652
Practice Address - Country:US
Practice Address - Phone:317-401-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service