Provider Demographics
NPI:1679946339
Name:ABALONE ACUPUNCTURE OF AUSTIN
Entity Type:Organization
Organization Name:ABALONE ACUPUNCTURE OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST, MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SLADE
Authorized Official - Middle Name:LANDRY
Authorized Official - Last Name:MANES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,MSOM,LMT,CMT
Authorized Official - Phone:512-203-1816
Mailing Address - Street 1:17909 LINKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2672
Mailing Address - Country:US
Mailing Address - Phone:512-203-1816
Mailing Address - Fax:
Practice Address - Street 1:802 W SAINT ELMO RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1153
Practice Address - Country:US
Practice Address - Phone:512-203-1816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01480261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center