Provider Demographics
NPI:1265550305
Name:MICHAEL R. CAVANAUGH, D.C. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL R. CAVANAUGH, D.C. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-984-5852
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1951617Medicaid
LA1951617Medicaid
LA59226Medicare ID - Type Unspecified
LA1951617Medicaid