Healthcare Provider Details

I. General information

NPI: 1013464551
Provider Name (Legal Business Name): ABUNDANT LIFE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11-1491 ALA RD
MOUNTAIN VIEW HI
96771-1826
US

IV. Provider business mailing address

PO BOX 711826 11-1491 ALA RD
MOUNTAIN VIEW HI
96771-1826
US

V. Phone/Fax

Practice location:
  • Phone: 808-209-1856
  • Fax:
Mailing address:
  • Phone: 808-209-1856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberDC1329
License Number StateHI

VIII. Authorized Official

Name: DR. SHAUNA DIANE LOVER
Title or Position: ORGANIZER
Credential: DC
Phone: 808-209-1856