Provider Demographics
NPI:1376840603
Name:ABUNDANT HEALTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ABUNDANT HEALTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-569-5476
Mailing Address - Street 1:585 MEDFORD AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1336
Mailing Address - Country:US
Mailing Address - Phone:631-569-5476
Mailing Address - Fax:
Practice Address - Street 1:585 MEDFORD AVE STE 10
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1336
Practice Address - Country:US
Practice Address - Phone:631-569-5476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010114-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty