Provider Demographics
NPI:1942230776
Name:MCCAVITT, MICHAEL SHAWN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:MCCAVITT
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 1:3711 N SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7132
Mailing Address - Country:US
Mailing Address - Phone:309-688-2271
Mailing Address - Fax:309-688-0920
Practice Address - Street 1:3711 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-7132
Practice Address - Country:US
Practice Address - Phone:309-688-2271
Practice Address - Fax:309-688-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDD8321OtherRAILRAOD
ILU97538Medicare UPIN
IL212069Medicare ID - Type UnspecifiedGROUP NUMBER