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General NPI Number Information
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NPI Number | 1336574466
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Entity Type | Organization
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Legal Business Name | ABSOLUTE LIFE WELLNESS CENTER, INC
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 1807 W SLAUGHTER LN SUITE 450
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City | AUSTIN
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State | TX
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Zip | 78748-6230
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Country | US
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Telephone | 512-280-6103
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 W SLAUGHTER LN SUITE 450
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City | AUSTIN
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State | TX
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Zip | 78748-6230
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | DR. DANIEL SHADDOCK
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Credential | D.C.
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Telephone | 512-280-6103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11665
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License Number State | TX
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