Provider Demographics
NPI:1457521007
Name:BLACKBURN, ABIGAIL HOLLIS (DC)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:HOLLIS
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3735
Mailing Address - Country:US
Mailing Address - Phone:512-810-0667
Mailing Address - Fax:
Practice Address - Street 1:4107 MEDICAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3736
Practice Address - Country:US
Practice Address - Phone:512-420-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor