Provider Demographics
NPI:1023371200
Name:WALRATH, CASSIDY ELAINE (DC)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:ELAINE
Last Name:WALRATH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 22 MILE RD
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:MI
Mailing Address - Zip Code:49245-9647
Mailing Address - Country:US
Mailing Address - Phone:872-230-1678
Mailing Address - Fax:
Practice Address - Street 1:3876 22 MILE RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:MI
Practice Address - Zip Code:49245-9647
Practice Address - Country:US
Practice Address - Phone:872-230-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012237111N00000X
MI2301010900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor