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General NPI Number Information
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NPI Number | 1972544690
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Entity Type | Individual
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Provider Name | THOMAS PAUL SUPERVILLE DC
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 2061 ANTOINE DR
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City | HOUSTON
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State | TX
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Zip | 77055-1840
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Country | US
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Telephone | 713-812-1880
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Fax | 713-812-1881
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Provider Business Mailing Address
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Address Line | 2065 HARLAND DR
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City | HOUSTON
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State | TX
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Zip | 77055-1823
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Country | US
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Telephone | 713-812-1880
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Fax | 173-812-1881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4527
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License Number State | TX
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