Provider Demographics
NPI:1962807560
Name:ABUNDANT LIFE CHIROPRACTIC INC
Entity type:Organization
Organization Name:ABUNDANT LIFE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:KLOPP-SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-292-9853
Mailing Address - Street 1:1615 WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-5062
Mailing Address - Country:US
Mailing Address - Phone:864-292-9853
Mailing Address - Fax:
Practice Address - Street 1:1615 WADE HAMPTON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-5062
Practice Address - Country:US
Practice Address - Phone:864-292-9853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2548261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU872550281OtherPTAN