Provider Demographics
NPI:1932466240
Name:ABUNDANT SPLENDOUR INCE
Entity Type:Organization
Organization Name:ABUNDANT SPLENDOUR INCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:954-907-9787
Mailing Address - Street 1:1732 NE 26TH ST
Mailing Address - Street 2:202
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1413
Mailing Address - Country:US
Mailing Address - Phone:954-907-9787
Mailing Address - Fax:
Practice Address - Street 1:1732 NE 26TH ST
Practice Address - Street 2:202
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1413
Practice Address - Country:US
Practice Address - Phone:954-907-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2412171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty