Provider Demographics
NPI:1053478628
Name:VITALITY STUDIOS
Entity type:Organization
Organization Name:VITALITY STUDIOS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:972-248-7488
Mailing Address - Street 1:PO BOX 260172
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-248-7488
Mailing Address - Fax:972-250-1924
Practice Address - Street 1:5072 WEST PLANO PARKWAY
Practice Address - Street 2:SUITE 170
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-248-7488
Practice Address - Fax:972-250-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty