Organization
VITALITY CHIRO PC
Active
Other names
Vitality Chiropractic Lifestyle Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLAS JIM FANNING D.C., M.S. (DOCTOR/PRESIDENT)
(402) 310-5790
Entity
Organization
Contact information
Practice address
10 N SPRUCE ST, OGALLALA, NE 69153-2549
(401) 310-5790
Mailing address
PO BOX 96, OGALLALA, NE 69153-0096
(402) 310-5790
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1567
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025511400
—
NE
Enumeration date
07/06/2011
Last updated
07/06/2011
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