MEDICARE: ABUNDANT HEALTH CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3381-012	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558384222	OTHER	WI	NPI INDIVIDUAL #

General Provider Information

NPI Number	:	1760713051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANT HEALTH CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1804 S ASHLAND AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-3702
Country	:	US
Telephone Number	:	920-405-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1804 S ASHLAND AVE
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-3702
Country	:	US
Telephone Number	:	920-405-9830
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. PATRICIA ANN RINDY
Credential	:	DC
Telephone Number	:	920-405-9830

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	01/26/2010

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