Vitality Life Chiropractic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4989 Issued in MN

Legal business name

VITALITY LIFE CHIROPRACTIC, LLC

Practice address

7250 France Ave S, Ste 300a
Edina, MN 55435-4305

Phone

(952) 835-4772

Fax

(763) 207-8381

NPI assigned

Oct 13, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Jason Lee Ellis, D.C.

Title

Owner

Phone

(952) 835-4772

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1507852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509062400000",
    "number": "1992216295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7250 FRANCE AVE S.",
            "address_2": "300A",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354346",
            "telephone_number": "952-835-4772",
            "fax_number": "763-207-8381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7250 FRANCE AVE S, STE 300A",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554354305",
            "telephone_number": "952-835-4772",
            "fax_number": "763-207-8381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY LIFE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-13",
        "last_updated": "2017-10-27",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-835-4772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Edina, MN
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2017; 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.