Provider Demographics
NPI:1962648097
Name:MICHAUD, KEVIN JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:MICHAUD
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 1:112 SPENCER ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4601
Mailing Address - Country:US
Mailing Address - Phone:860-533-0094
Mailing Address - Fax:860-533-0122
Practice Address - Street 1:112 SPENCER ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4601
Practice Address - Country:US
Practice Address - Phone:860-533-0094
Practice Address - Fax:860-533-0122
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor