Provider Demographics
NPI:1780096560
Name:ABUNDANT LIFE CHIROPRACTIC OF BELTON, P.C.
Entity type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC OF BELTON, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-331-8900
Mailing Address - Street 1:114 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2400
Mailing Address - Country:US
Mailing Address - Phone:816-331-8900
Mailing Address - Fax:816-331-8905
Practice Address - Street 1:114 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2400
Practice Address - Country:US
Practice Address - Phone:816-331-8900
Practice Address - Fax:816-331-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008011449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1178Medicare PIN