Provider Demographics
NPI:1962783050
Name:ABUNDANT LIFE CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:443-686-1407
Mailing Address - Street 1:2 GULL CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-6314
Mailing Address - Country:US
Mailing Address - Phone:443-686-1407
Mailing Address - Fax:
Practice Address - Street 1:9660 BELAIR RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-1119
Practice Address - Country:US
Practice Address - Phone:410-256-1672
Practice Address - Fax:410-256-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty