Provider Demographics
NPI:1073662615
Name:CAVELLI, JOSEPH GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GEORGE
Last Name:CAVELLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-0041
Mailing Address - Country:US
Mailing Address - Phone:713-941-7949
Mailing Address - Fax:713-941-8053
Practice Address - Street 1:3400 S SHAVER ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77587-4487
Practice Address - Country:US
Practice Address - Phone:713-941-7949
Practice Address - Fax:713-941-8053
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4651OtherSTATE LICENSE
TX601920Medicare ID - Type UnspecifiedBCBS