Provider Demographics
NPI:1053874024
Name:VIBRANT HEALTH CHIROPRACTIC LLC
Entity type:Organization
Organization Name:VIBRANT HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:STRODE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-714-3483
Mailing Address - Street 1:411 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:61238-1402
Mailing Address - Country:US
Mailing Address - Phone:309-714-3483
Mailing Address - Fax:
Practice Address - Street 1:411 SOUTH RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:IL
Practice Address - Zip Code:61238-1402
Practice Address - Country:US
Practice Address - Phone:309-714-3483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty