Provider Demographics
NPI:1346631553
Name:ABUNDANT LIFE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ORVILLE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:405-350-0916
Mailing Address - Street 1:324 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-2627
Mailing Address - Country:US
Mailing Address - Phone:405-350-0916
Mailing Address - Fax:405-350-0921
Practice Address - Street 1:324 ELM AVE
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-2627
Practice Address - Country:US
Practice Address - Phone:405-350-0916
Practice Address - Fax:405-350-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2426111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK640832704OtherDCN