Provider Demographics
NPI:1063600518
Name:ABUNDANT LIFE CHIROPRACTIC PA
Entity type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-721-0060
Mailing Address - Street 1:2300 HUTTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4403
Mailing Address - Country:US
Mailing Address - Phone:913-721-0060
Mailing Address - Fax:913-721-2553
Practice Address - Street 1:2300 HUTTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4403
Practice Address - Country:US
Practice Address - Phone:913-721-0060
Practice Address - Fax:913-721-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS27743036OtherBLUE CROSS BLUE SHIELD
KS27743036OtherBLUE CROSS BLUE SHIELD