10D2013318 CLIA NUMBER - TOTAL VITALITY MEDICAL GROUP LLC

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Laboratory Demographics

CLIA Number: 10D2013318

Facility Name: TOTAL VITALITY MEDICAL GROUP LLC

Facility Address:
24945 US HWY 19 N
CLEARWATER, FL
ZIP 33763
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Facility Phone Number: 727 726-1460

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1366672057

Taxonomy: 111N00000X - Chiropractor
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

CLIA Record

Field Name	Field Value
CLIA Number	10D2013318
LAB Type	Physician Office
Facility Name	TOTAL VITALITY MEDICAL GROUP LLC
Street	24945 US HWY 19 N
City	CLEARWATER
State	FL
ZIP	33763
Phone	727 726-1460
CertificateType	4
CertificateEffectiveDate	9/17/2022
CertificateExpirationDate	9/16/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024