Provider Demographics
NPI:1265854434
Name:MANES, SLADE (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:SLADE
Middle Name:
Last Name:MANES
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305B WESTERN TRAILS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1634
Mailing Address - Country:US
Mailing Address - Phone:512-203-1816
Mailing Address - Fax:
Practice Address - Street 1:2111 DICKSON DR
Practice Address - Street 2:22
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4796
Practice Address - Country:US
Practice Address - Phone:512-203-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01480171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist