Provider Demographics
NPI:1366706426
Name:VITALITY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:VITALITY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:TOWERS
Authorized Official - Last Name:BONDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-955-4750
Mailing Address - Street 1:5524 S SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4421
Mailing Address - Country:US
Mailing Address - Phone:810-344-9279
Mailing Address - Fax:810-344-9470
Practice Address - Street 1:857 HEALTH PARK BLVD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7383
Practice Address - Country:US
Practice Address - Phone:810-344-9279
Practice Address - Fax:810-344-9470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty