NPIMap

Organization Active NPI

Vitality Chiro PC

Doing business as Vitality Chiropractic Lifestyle Center

  • Chiropractor
  • Ogallala, NE
National Provider Identifier
1376830810
Registry record updated Jul 6, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1567 Issued in NE
Legal business name
VITALITY CHIRO PC
Doing business as
Vitality Chiropractic Lifestyle Center
Practice address
10 N Spruce St
Ogallala, NE 69153-2549
Phone
(401) 310-5790
NPI assigned
Jul 6, 2011
Last updated
Jul 6, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Nicolas Jim Fanning, D.C., M.S.NPI 1760616023
Title
Doctor/President
Phone
(402) 310-5790

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 1567 NE Primary

Addresses

Primary practice location

10 N Spruce St
Ogallala, NE 69153-2549

Mailing address

PO Box 96
Ogallala, NE 69153-0096
Phone (402) 310-5790

Other identifiers 1

IdentifierTypeStateIssuer
10025511400MedicaidNE

Other names 1

  • Vitality Chiropractic Lifestyle Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120223000595 NE Part B Supplier - Clinic/Group Practice 9032377940 Receives reassigned benefits from 1 practitioner
Practice locations: Ogallala, NE

National Provider Directory

National Provider Directory
Tax ID family
Vitality Chiro PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10 N Spruce St
Ste A
Ogallala, NE 69153
Phone (308) 284-0838

10 N Spruce St
Ogallala, NE 69153
Phone (401) 310-5790

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309910400000",
    "number": "1376830810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "OGALLALA",
            "state": "NE",
            "postal_code": "691530096",
            "telephone_number": "402-310-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 N SPRUCE ST",
            "city": "OGALLALA",
            "state": "NE",
            "postal_code": "691532549",
            "telephone_number": "401-310-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY CHIRO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-06",
        "last_updated": "2011-07-06",
        "status": "A",
        "authorized_official_last_name": "FANNING",
        "authorized_official_first_name": "NICOLAS",
        "authorized_official_middle_name": "JIM",
        "authorized_official_title_or_position": "DOCTOR/PRESIDENT",
        "authorized_official_telephone_number": "402-310-5790",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., M.S."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025511400",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Chiropractic Lifestyle Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ogallala, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.