Healthcare Provider Details

I. General information

NPI: 1093148751
Provider Name (Legal Business Name): MICHAEL MCCAFFRIE CHIROPRACTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ROSE LOOP
FORT LEAVENWORTH KS
66027-1212
US

IV. Provider business mailing address

104 ROSE LOOP
FORT LEAVENWORTH KS
66027-1212
US

V. Phone/Fax

Practice location:
  • Phone: 706-615-9302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO009155
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT004135
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: