Provider Demographics
NPI:1265457758
Name:CAUDELL, LAWRENCE ELTON JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ELTON
Last Name:CAUDELL
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:448 W 19TH ST
Mailing Address - Street 2:SUITE 239
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3914
Mailing Address - Country:US
Mailing Address - Phone:832-788-8739
Mailing Address - Fax:713-861-8739
Practice Address - Street 1:3074 COLLEGE PARK DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-8002
Practice Address - Country:US
Practice Address - Phone:936-321-5600
Practice Address - Fax:936-271-5665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX9002111NX0100X
AZ3772225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C9699Medicare ID - Type Unspecified
TXV02741Medicare UPIN