Provider Demographics
NPI:1306049804
Name:DUNHAM, CORNELIA (LAC)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 BRODIE LANE, C5
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748
Mailing Address - Country:US
Mailing Address - Phone:512-280-7715
Mailing Address - Fax:
Practice Address - Street 1:9001 BRODIE LANE, C5
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:512-280-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist