MEDICARE: ABALONE ACUPUNCTURE OF AUSTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	AC01480	TX

General Provider Information

NPI Number	:	1679946339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABALONE ACUPUNCTURE OF AUSTIN

Provider Business Mailing Address
First Line	:	17909 LINKVIEW DR
Second Line	:
City	:	DRIPPING SPRINGS
State	:	TX
Zip	:	78620-2672
Country	:	US
Telephone Number	:	512-203-1816
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 W SAINT ELMO RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-1153
Country	:	US
Telephone Number	:	512-203-1816
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST, MASSAGE THERAPIST
Name	:	MR. SLADE LANDRY MANES
Credential	:	LAC,MSOM,LMT,CMT
Telephone Number	:	512-203-1816

Provider Enumeration Date	:	11/03/2015
Last Update Date	:	11/03/2015

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