MEDICARE: DR. JOSEPH GEORGE CAVELLI DC

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	111N00000X	Chiropractor	4651	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4651	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1073662615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH GEORGE CAVELLI DC

Provider Business Mailing Address
First Line	:	PO BOX 41
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-0041
Country	:	US
Telephone Number	:	713-941-7949
Fax Number	:	713-941-8053

Provider Business Practice Location Address
First Line	:	3400 S SHAVER ST
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4487
Country	:	US
Telephone Number	:	713-941-7949
Fax Number	:	713-941-8053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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