Provider Demographics
NPI:1851568919
Name:ABUNDANT WELLNESS AND MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ABUNDANT WELLNESS AND MEDICAL CENTER INC
Other - Org Name:HEALTH-1ST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-324-4431
Mailing Address - Street 1:1927 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4217
Mailing Address - Country:US
Mailing Address - Phone:661-324-4431
Mailing Address - Fax:661-324-5616
Practice Address - Street 1:1927 21ST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4217
Practice Address - Country:US
Practice Address - Phone:661-324-4431
Practice Address - Fax:661-324-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty