Provider Demographics
NPI:1841570819
Name:CAVANAUGH, MATTHEW JUDE (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JUDE
Last Name:CAVANAUGH
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 1:105 INDEPENDENCE BLVD
Mailing Address - Street 2:STE. 3
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-8710
Mailing Address - Country:US
Mailing Address - Phone:337-984-5852
Mailing Address - Fax:337-984-5851
Practice Address - Street 1:105 INDEPENDENCE BLVD
Practice Address - Street 2:STE. 3
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-8710
Practice Address - Country:US
Practice Address - Phone:337-984-5852
Practice Address - Fax:337-984-5851
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor