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NPI Code Detail

MEDICARE: DR. MICHAEL TAKESHI CAVALLA D.C.

MEDICARE: DR. MICHAEL TAKESHI CAVALLA D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor38MC00500300NJ

General Provider Information

NPI Number : 1477603637
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL TAKESHI CAVALLA D.C.
Provider Business Mailing Address
First Line : 560 SPRINGFIELD AVE
Second Line : SUITE 2A
City : WESTFIELD
State : NJ
Zip : 07090-1024
Country : US
Telephone Number : 908-301-9222
Fax Number : 908-301-9148
Provider Business Practice Location Address
First Line : 560 SPRINGFIELD AVE
Second Line : SUITE 2A
City : WESTFIELD
State : NJ
Zip : 07090-1024
Country : US
Telephone Number : 908-301-9222
Fax Number : 908-301-9148
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2007
Last Update Date : 07/08/2007

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