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Organization
VITALITY LIFE CHIROPRACTIC, LLC
Active
Organization
VITALITY LIFE CHIROPRACTIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON LEE ELLIS D.C. (DOCTOR OF CHIROPRACTIC/ OWNER)
(952) 835-4772
Entity
Organization
Contact information
Practice address
7250 FRANCE AVE S, 300A, EDINA, MN 55435-5173
(952) 835-4772
(763) 207-8381
Mailing address
4444 W 76TH ST, 400, EDINA, MN 55435-5173
(952) 835-4772
(763) 207-8381
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4989
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060468000
MHCP
MN
01
—
3I334VI
BCBS
MN
01
—
CC1343A
CHIROCARE
MN
Enumeration date
12/10/2007
Last updated
10/30/2017
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