NPIMap

Organization Active NPI

Proactive Health and Wellness, LLC

Doing business as Vitality Chiropractic

  • Chiropractor
  • Rockville, MD
National Provider Identifier
1730748302
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PROACTIVE HEALTH AND WELLNESS, LLC
Doing business as
Vitality Chiropractic
Practice address
6101 Executive Blvd.
Ste 380
Rockville, MD 20852-3910
Phone
(301) 231-0050
Fax
(301) 231-6056
NPI assigned
Jun 7, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Dr. Diego Fernando Proano, DCNPI 1710209408
Title
Owner
Phone
(301) 231-0050

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: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

6101 Executive Blvd.
Ste 380
Rockville, MD 20852-3910

Mailing address

6101 Executive Blvd.
Ste 380
Rockville, MD 20852-3910
Phone (301) 231-0050

Other names 1

  • Vitality Chiropractic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200803000056 DC Part B Supplier - Clinic/Group Practice 0446675847 Receives reassigned benefits from 1 practitioner
Practice locations: Rockville, MD

National Provider Directory

National Provider Directory

Locations

6101 Executive Blvd
Ste 380
Rockville, MD 20852
Phone (301) 231-0050

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1559865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1730748302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 EXECUTIVE BLVD.",
            "address_2": "STE 380",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523910",
            "telephone_number": "301-231-0050",
            "fax_number": "301-231-6056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 EXECUTIVE BLVD.",
            "address_2": "STE 380",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208523910",
            "telephone_number": "301-231-0050",
            "fax_number": "301-231-6056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE HEALTH AND WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-07",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "PROANO",
        "authorized_official_first_name": "DIEGO",
        "authorized_official_middle_name": "FERNANDO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-231-0050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitality Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vitality Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.