Provider Demographics
NPI:1023067188
Name:MCAVOY, TOM L (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:L
Last Name:MCAVOY
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 155
Mailing Address - Street 2:
Mailing Address - City:SELMAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75689-0155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:617 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-2675
Practice Address - Country:US
Practice Address - Phone:903-657-4891
Practice Address - Fax:903-657-6871
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609296Medicare ID - Type Unspecified
461088Medicare UPIN