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General NPI Number Information
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NPI Number | 1841550365
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Entity Type | Organization
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Legal Business Name | MELINDA M BREAZ CHIROPRACTIC CLINIC, PC
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Dates
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Enumeration Date | 05/17/2012
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Last Update Date | 05/17/2012
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Provider Practice Location Address
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Address Line | 5572 ASPEN ST
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City | BELLAIRE
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State | TX
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Zip | 77401-4829
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Country | US
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Telephone | 713-812-1880
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Fax | 713-667-1453
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Provider Business Mailing Address
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Address Line | 5572 ASPEN ST
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City | BELLAIRE
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State | TX
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Zip | 77401-4829
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Country | US
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Telephone | 713-812-1880
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Fax | 713-667-1453
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. THOMAS PAUL SUPERVILLE
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Credential | DC
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Telephone | 713-812-1880
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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 | DC4527
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License Number State | TX
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