Provider Demographics
NPI:1003901174
Name:KASSMEIER, DAVID G (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:KASSMEIER
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 1:1502 N 13TH ST
Mailing Address - Street 2:PO BOX 1371
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2381
Mailing Address - Country:US
Mailing Address - Phone:402-371-6415
Mailing Address - Fax:402-371-2883
Practice Address - Street 1:1502 N 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2381
Practice Address - Country:US
Practice Address - Phone:402-371-6415
Practice Address - Fax:402-371-2883
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081337803Medicaid
09613OtherBLUE CROSS BLUE SHIELD
NE47081337805Medicaid
9613OtherBLUE CROSS BLUE SHIELD
270784KAMedicare ID - Type Unspecified
09613OtherBLUE CROSS BLUE SHIELD