Vibrant Health Family Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4872 Issued in MN

Legal business name

VIBRANT HEALTH FAMILY CHIROPRACTIC LLC

Practice address

4080 Tower Street
Suite 1080
St Bonifacius, MN 55375

Phone

(952) 446-9600

Fax

(952) 446-9603

NPI assigned

Oct 27, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Susan Laurie Herda, DC

Title

Owner

Phone

(952) 446-9600

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256601600000",
    "number": "1427384478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4080 TOWER STREET",
            "address_2": "SUITE 1080",
            "city": "ST BONIFACIUS",
            "state": "MN",
            "postal_code": "55375",
            "telephone_number": "952-446-9600",
            "fax_number": "952-446-9603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 TOWER STREET",
            "address_2": "SUITE 1080",
            "city": "ST BONIFACIUS",
            "state": "MN",
            "postal_code": "55375",
            "telephone_number": "952-446-9600",
            "fax_number": "952-446-9603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT HEALTH FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-27",
        "last_updated": "2009-10-27",
        "status": "A",
        "authorized_official_last_name": "HERDA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "LAURIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-446-9600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tricia Anne Miller, OTR/L
• Karen Moberg, M.ED, ATC
• Sonja Squiers, MS, LAT, ATC
• St Bonifacius Chiropractic L.L.C. (St. Bonifacius Chiropractic)
• Nathan Michael Tellers, ATC

• Chiropractor in St Bonifacius, MN
• Providers in St Bonifacius, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.