Provider Demographics
NPI:1417238742
Name:ABUNDANT LIFE CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-777-0058
Mailing Address - Street 1:248 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1358
Mailing Address - Country:US
Mailing Address - Phone:973-777-0058
Mailing Address - Fax:973-405-6529
Practice Address - Street 1:248 EDISON ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1358
Practice Address - Country:US
Practice Address - Phone:973-777-0058
Practice Address - Fax:973-405-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00576600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty