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General NPI Number Information
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NPI Number | 1639368301
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 22002 64TH AVE W SUITE 2E
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2528
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Country | US
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Telephone | 425-774-7982
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Fax | 425-672-4464
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Provider Business Mailing Address
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Address Line | 22002 64TH AVE W SUITE 2E
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City | MOUNTLAKE TERRACE
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State | WA
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Zip | 98043-2528
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Country | US
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Telephone | 425-774-7982
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Fax | 425-672-4464
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MARY K WRIGHT
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Credential | D.C.
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Telephone | 425-774-7982
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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 | CH00002908
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License Number State | WA
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