Provider Demographics
NPI:1114219334
Name:ABUNDANT LIFE WELLNESS CENTER
Entity Type:Organization
Organization Name:ABUNDANT LIFE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:TREJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-847-0900
Mailing Address - Street 1:3345 WESTERN CENTER BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1937
Mailing Address - Country:US
Mailing Address - Phone:817-847-0900
Mailing Address - Fax:817-847-0929
Practice Address - Street 1:3345 WESTERN CENTER BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1937
Practice Address - Country:US
Practice Address - Phone:817-847-0900
Practice Address - Fax:817-847-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty