Abundant Life Health Center LLC
Organization Active NPI Chiropractor · St. Johns, FL
NPI 1003328022 · NPPES record last updated Oct 31, 2017
Key facts
- NPI
- 1003328022
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CH12184 (FL)
- Legal business name
- ABUNDANT LIFE HEALTH CENTER LLC
- Practice address
- 254 Everest Lane
St. Johns, FL 32259 - Phone
- (904) 862-2662
- NPI assigned
- Oct 31, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Vassil I Valov, DC
- Title
- Owner
- Phone
- (904) 862-2662
Practitioners 1
-
Vassil I Valov, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171214000449 | FL | Part B Supplier - Clinic/Group Practice | 3971861261 |
Receives reassigned benefits from 1 practitioner Practice locations: St Johns, FL |
National Provider Directory
Locations
254 Everest Ln
St Johns, FL 32259
Phone (904) 862-2662
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CH12184 | FL | Yes |
Addresses
Primary practice location
254 Everest Lane
St. Johns, FL 32259
Mailing address
56 Canary Palm CT
Ponte Vedra, FL 32081-6100
Phone (904) 862-2662
Other providers in St. Johns, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 31, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.