Provider Demographics
NPI:1104908672
Name:ABELLE, MARK S (DIPLAC, LAC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:ABELLE
Suffix:
Gender:M
Credentials:DIPLAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2113
Mailing Address - Country:US
Mailing Address - Phone:541-488-5719
Mailing Address - Fax:541-842-6150
Practice Address - Street 1:581 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2113
Practice Address - Country:US
Practice Address - Phone:541-488-5719
Practice Address - Fax:541-842-6150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00125171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist