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General NPI Number Information
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NPI Number | 1417261280
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIVING MEDICAL CLINIC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 3100 OLD TODDS RD SUITE 150
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City | LEXINGTON
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State | KY
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Zip | 40509-5006
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Country | US
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Telephone | 859-263-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 OLD TODDS RD SUITE 150
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City | LEXINGTON
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State | KY
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Zip | 40509-5006
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Country | US
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Telephone | 859-263-4900
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | MR. MICHAEL BETTS
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Credential |
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Telephone | 859-263-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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