MEDICARE: ABUNDANT LIFE CHIROPRACTIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4742	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27743036	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1063600518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT LIFE CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	2300 HUTTON RD
Second Line	:	SUITE 101
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4403
Country	:	US
Telephone Number	:	913-721-0060
Fax Number	:	913-721-2553

Provider Business Practice Location Address
First Line	:	2300 HUTTON RD
Second Line	:	SUITE 101
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4403
Country	:	US
Telephone Number	:	913-721-0060
Fax Number	:	913-721-2553

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WENDY ANN BRILEY
Credential	:	D.C.
Telephone Number	:	913-721-0060

Provider Enumeration Date	:	10/10/2007
Last Update Date	:	02/01/2012

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