Provider Demographics
NPI:1063597391
Name:RAFFERTY, MICHAEL HAROLD (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAROLD
Last Name:RAFFERTY
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 1:653 MAIN ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1502
Mailing Address - Country:US
Mailing Address - Phone:763-441-2411
Mailing Address - Fax:
Practice Address - Street 1:653 MAIN ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1502
Practice Address - Country:US
Practice Address - Phone:763-441-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44-48325OtherMEDICA
MN27247RAOtherBLUE CROSS / BLUE SHIELD