Provider Demographics
NPI:1205938370
Name:ABUNDANT LIFE WELLNESS CENTER
Entity type:Organization
Organization Name:ABUNDANT LIFE WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-345-2221
Mailing Address - Street 1:10709 BARKLEY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1152
Mailing Address - Country:US
Mailing Address - Phone:913-345-2221
Mailing Address - Fax:913-345-2270
Practice Address - Street 1:10709 BARKLEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1152
Practice Address - Country:US
Practice Address - Phone:913-345-2221
Practice Address - Fax:913-345-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST44097Medicare UPIN