Provider Demographics
NPI:1356553044
Name:ABUNDANT LIFE CHIROPRACTIC LTD
Entity type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZUELKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-261-0001
Mailing Address - Street 1:350 W 22ND ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6449
Mailing Address - Country:US
Mailing Address - Phone:630-261-0001
Mailing Address - Fax:630-261-0607
Practice Address - Street 1:350 W 22ND ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6449
Practice Address - Country:US
Practice Address - Phone:630-261-0001
Practice Address - Fax:630-261-0607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038005090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT38408Medicare UPIN
IL743220Medicare ID - Type Unspecified