Provider Demographics
NPI:1447436944
Name:VITALITY HEALTH AND WELLNESS
Entity type:Organization
Organization Name:VITALITY HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-746-1256
Mailing Address - Street 1:12100 SINGLETREE LN STE 129
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7937
Mailing Address - Country:US
Mailing Address - Phone:952-746-1256
Mailing Address - Fax:
Practice Address - Street 1:12100 SINGLETREE LN STE 129
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7937
Practice Address - Country:US
Practice Address - Phone:952-746-1256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty