Provider Demographics
NPI:1164877585
Name:SPELL, CHRISTANNE
Entity Type:Individual
Prefix:
First Name:CHRISTANNE
Middle Name:
Last Name:SPELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12915 JONES MALTSBERGER RD
Mailing Address - Street 2:BLDG. 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4282
Mailing Address - Country:US
Mailing Address - Phone:512-653-5194
Mailing Address - Fax:
Practice Address - Street 1:12915 JONES MALTSBERGER RD
Practice Address - Street 2:BLDG. 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4282
Practice Address - Country:US
Practice Address - Phone:512-653-5194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01681171100000X
TXAC01619171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist