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General NPI Number Information
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NPI Number | 1356553044
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE CHIROPRACTIC LTD
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 350 W 22ND ST SUITE 112
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City | LOMBARD
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State | IL
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Zip | 60148-6449
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Country | US
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Telephone | 630-261-0001
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Fax | 630-261-0607
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Provider Business Mailing Address
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Address Line | 350 W 22ND ST SUITE 112
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City | LOMBARD
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State | IL
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Zip | 60148-6449
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Country | US
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Telephone | 630-261-0001
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Fax | 630-261-0607
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID S ZUELKE
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Credential | D.C.
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Telephone | 630-261-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 038005090
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License Number State | IL
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