Provider Demographics
NPI:1376723064
Name:ABUNDANT LIFE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC, INC.
Other - Org Name:ROCKET CITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-721-9617
Mailing Address - Street 1:2417 JORDAN LN NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1009
Mailing Address - Country:US
Mailing Address - Phone:256-721-9617
Mailing Address - Fax:256-837-1206
Practice Address - Street 1:2417 JORDAN LN NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1009
Practice Address - Country:US
Practice Address - Phone:256-721-9617
Practice Address - Fax:256-837-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty