Healthcare Provider Details

I. General information

NPI: 1851568919
Provider Name (Legal Business Name): ABUNDANT WELLNESS AND MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 21ST ST
BAKERSFIELD CA
93301-4217
US

IV. Provider business mailing address

1927 21ST ST
BAKERSFIELD CA
93301-4217
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4431
  • Fax: 661-324-5616
Mailing address:
  • Phone: 661-324-4431
  • Fax: 661-324-5616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. VINCENT STEVEN BOOTH
Title or Position: VICE PRESIDENT
Credential: DC
Phone: 661-324-4431