Provider Demographics
NPI:1174664072
Name:ABUNDANT LIFE WELLNESS CENTER INC.
Entity Type:Organization
Organization Name:ABUNDANT LIFE WELLNESS CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SEWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC LMT
Authorized Official - Phone:770-973-5775
Mailing Address - Street 1:2231-C ROBINSON ROAD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068
Mailing Address - Country:US
Mailing Address - Phone:770-973-5775
Mailing Address - Fax:770-973-2257
Practice Address - Street 1:2231-C ROBINSON ROAD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068
Practice Address - Country:US
Practice Address - Phone:770-973-5775
Practice Address - Fax:770-973-2257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO02622111N00000X
GACHIR007814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty