Provider Demographics
NPI:1811263270
Name:ABUNDANT LIFE FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ABUNDANT LIFE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LASSETER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-840-4000
Mailing Address - Street 1:102 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-1606
Mailing Address - Country:US
Mailing Address - Phone:256-840-4000
Mailing Address - Fax:256-840-4008
Practice Address - Street 1:100 BEL AIR ST
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957
Practice Address - Country:US
Practice Address - Phone:256-840-4000
Practice Address - Fax:256-840-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty