Provider Demographics
NPI:1477603637
Name:CAVALLA, MICHAEL TAKESHI (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TAKESHI
Last Name:CAVALLA
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 1:560 SPRINGFIELD AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-1024
Mailing Address - Country:US
Mailing Address - Phone:908-301-9222
Mailing Address - Fax:908-301-9148
Practice Address - Street 1:560 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1024
Practice Address - Country:US
Practice Address - Phone:908-301-9222
Practice Address - Fax:908-301-9148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00500300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCA711042Medicare ID - Type UnspecifiedCHIROPRACTOR