Provider Demographics
NPI:1215001565
Name:HARVEY, MICHAEL T (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:HARVEY
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 1:1212 STUBBS AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5622
Mailing Address - Country:US
Mailing Address - Phone:318-325-6685
Mailing Address - Fax:318-322-7425
Practice Address - Street 1:1212 STUBBS AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5622
Practice Address - Country:US
Practice Address - Phone:318-325-6685
Practice Address - Fax:318-322-7425
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU69937Medicare UPIN
LA5X466Medicare ID - Type UnspecifiedPROVIDER NUMBER