Provider Demographics
NPI:1437274081
Name:ABUNDANT LIFE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:SHEFCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-265-9976
Mailing Address - Street 1:1203 S MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-2120
Mailing Address - Country:US
Mailing Address - Phone:920-265-9976
Mailing Address - Fax:
Practice Address - Street 1:1203 S MILITARY AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2120
Practice Address - Country:US
Practice Address - Phone:920-499-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4298-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty