Provider Demographics
NPI:1275649881
Name:LEVESQUE, MICHAEL M (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:LEVESQUE
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 1:1 STAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2394
Mailing Address - Country:US
Mailing Address - Phone:413-214-7401
Mailing Address - Fax:413-214-7402
Practice Address - Street 1:1 STAFFORD ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2394
Practice Address - Country:US
Practice Address - Phone:413-214-7401
Practice Address - Fax:413-214-7402
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor