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General NPI Number Information
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NPI Number | 1962783050
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE CHIROPRACTIC, P.C.
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 9660 BELAIR RD
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City | NOTTINGHAM
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State | MD
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Zip | 21236-1119
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Country | US
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Telephone | 410-256-1672
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Fax | 410-256-1674
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Provider Business Mailing Address
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Address Line | 2 GULL CIR
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City | NORTH EAST
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State | MD
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Zip | 21901-6314
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Country | US
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Telephone | 443-686-1407
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN ANNE BATES
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Credential | D.C.
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Telephone | 443-686-1407
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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 | 03602
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License Number State | MD
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