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General NPI Number Information
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NPI Number | 1265821706
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE CHIROPRACTIC HEALTH CENTER PA
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 7945 STONE CREEK DR STE 120
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City | CHANHASSEN
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State | MN
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Zip | 55317-4606
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Country | US
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Telephone | 712-389-4827
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Fax |
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Provider Business Mailing Address
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Address Line | 7945 STONE CREEK DR STE 120
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City | CHANHASSEN
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State | MN
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Zip | 55317-4606
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | BENJAMIN ADAM KNIGHT
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Credential | D.C.
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Telephone | 712-389-4827
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 6026
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License Number State | MN
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