Provider Demographics
NPI:1841262920
Name:CAVALLO, LOUIS J (DC)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:CAVALLO
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 1:1503 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-678-8555
Mailing Address - Fax:303-678-2931
Practice Address - Street 1:1503 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3201
Practice Address - Country:US
Practice Address - Phone:303-678-8555
Practice Address - Fax:303-678-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00518000111N00000X
CO5821111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ621921OtherUNTIED HC
COC805580OtherMEDICAREPTAN
NJP833467OtherOXFORD
NJ2230355OtherAETNA
NJ1K0384OtherHEALTHNET
NJ2422986000OtherAMERIHEALTH/BLUE CROSS
NJ7858400Medicaid
NJP00236812OtherRAILROAD MEDICARE
NJP833467OtherOXFORD
NJ2422986000OtherAMERIHEALTH/BLUE CROSS
NJU90263Medicare UPIN
NJP00236812OtherRAILROAD MEDICARE