# NEW AGE VITALITY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700251626
- **Authorized official:** KRISTY WIREMAN (OWNER)
- **Authorized official phone:** (606) 789-8531

## Contact information

- **Practice address:** 327 BROADWAY ST, PAINTSVILLE, KY 41240-1348
- **Practice address phone:** (606) 789-8531
- **Practice address fax:** (606) 789-8893
- **Mailing address:** 327 BROADWAY ST, PAINTSVILLE, KY 41240-1348
- **Mailing address phone:** (606) 789-8531
- **Mailing address fax:** (606) 789-8893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2015
- **Last updated:** 03/08/2016