Provider Demographics
NPI:1639368301
Name:ABUNDANT LIFE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:ABUNDANT LIFE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:425-774-7982
Mailing Address - Street 1:22002 64TH AVE W
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2528
Mailing Address - Country:US
Mailing Address - Phone:425-774-7982
Mailing Address - Fax:425-672-4464
Practice Address - Street 1:22002 64TH AVE W
Practice Address - Street 2:SUITE 2E
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2528
Practice Address - Country:US
Practice Address - Phone:425-774-7982
Practice Address - Fax:425-672-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU51621Medicare UPIN
WAGAB40230Medicare PIN