Provider Demographics
NPI:1962450866
Name:CAVANAUGH, MICHAEL R (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
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. STE.#3
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-2702
Mailing Address - Country:US
Mailing Address - Phone:337-984-5852
Mailing Address - Fax:337-984-5851
Practice Address - Street 1:105 INDEPENDENCE BLVD. STE.#3
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-2702
Practice Address - Country:US
Practice Address - Phone:337-984-5852
Practice Address - Fax:337-984-5851
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1951617Medicaid
LAF6802OtherBLUE CROSS BLUE SHIELD
LAT75543Medicare UPIN
LA1951617Medicaid