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
300A
Edina, MN 55435-5173

Phone

(952) 835-4772

Fax

(763) 207-8381

NPI assigned

Dec 10, 2007

Last updated

Oct 30, 2017By the provider in NPPES

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.NPI 1700914140

Title

Doctor of Chiropractic/ Owner

Phone

(952) 835-4772

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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.

• Jason Lee Ellis, D.C.

  • Chiropractor
  • Edina, MN
  • NPI 1700914140
  Authorized official Same address or phone

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

{
    "created_epoch": "1197244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509321600000",
    "number": "1992988216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 W 76TH ST",
            "address_2": "400",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355173",
            "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",
            "address_2": "300A",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355173",
            "telephone_number": "952-835-4772",
            "fax_number": "763-207-8381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY LIFE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-10",
        "last_updated": "2017-10-30",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC/ OWNER",
        "authorized_official_telephone_number": "952-835-4772",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3I334VI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "060468000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROCARE",
            "identifier": "CC1343A",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Edina, MN
• Providers in Edina, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.