MEDICARE: DR. LAWRENCE ELTON CAUDELL JR. D.C.

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	111NX0100X	Occupational Health Chiropractor	9002	TX
2	225400000X	Rehabilitation Practitioner	3772	AZ

General Provider Information

NPI Number	:	1265457758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ELTON CAUDELL JR. D.C.

Provider Business Mailing Address
First Line	:	448 W 19TH ST
Second Line	:	SUITE 239
City	:	HOUSTON
State	:	TX
Zip	:	77008-3914
Country	:	US
Telephone Number	:	832-788-8739
Fax Number	:	713-861-8739

Provider Business Practice Location Address
First Line	:	3074 COLLEGE PARK DR
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-8002
Country	:	US
Telephone Number	:	936-321-5600
Fax Number	:	936-271-5665

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	02/17/2012

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