Provider Demographics
NPI:1669803045
Name:ABUNDANT LIFE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KRAGT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-885-3999
Mailing Address - Street 1:1925 N WENATCHEE AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8332
Mailing Address - Country:US
Mailing Address - Phone:509-885-3999
Mailing Address - Fax:
Practice Address - Street 1:1925 N WENATCHEE AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-8332
Practice Address - Country:US
Practice Address - Phone:509-885-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60429423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty