Provider Demographics
NPI:1497888325
Name:HARVEY, MICHAEL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
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 1:212 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2778
Mailing Address - Country:US
Mailing Address - Phone:507-835-2425
Mailing Address - Fax:507-835-5818
Practice Address - Street 1:212 15TH AVE NE
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2778
Practice Address - Country:US
Practice Address - Phone:507-835-2425
Practice Address - Fax:507-835-5818
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002430111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN002430OtherSTATE LICENSE
MN59582OtherMNPIN
MN36029BEOtherBC PRACTICE ID
MN59582OtherBC INDIVIDUAL
MNU30227Medicare UPIN