Provider Demographics
NPI:1003119397
Name:CASSA, TAMMY KAY (DC, CME)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:KAY
Last Name:CASSA
Suffix:
Gender:F
Credentials:DC, CME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 PEACH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1369
Mailing Address - Country:US
Mailing Address - Phone:814-923-6024
Mailing Address - Fax:
Practice Address - Street 1:4510 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1369
Practice Address - Country:US
Practice Address - Phone:814-923-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30986111N00000X
PADC 010744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA340459OtherMEDICARE PTAN