Provider Demographics
NPI:1285969881
Name:CAVANAUGH, WESLEY MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:MICHAEL
Last Name:CAVANAUGH
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 1:33560 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2030
Mailing Address - Country:US
Mailing Address - Phone:440-937-8087
Mailing Address - Fax:440-937-8106
Practice Address - Street 1:380 EMPIRE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2677
Practice Address - Country:US
Practice Address - Phone:303-604-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6428111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor