Provider Demographics
NPI:1073573234
Name:CASSISTA, GERARD R (BS,DC)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:R
Last Name:CASSISTA
Suffix:
Gender:M
Credentials:BS,DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3497
Mailing Address - Country:US
Mailing Address - Phone:978-957-5585
Mailing Address - Fax:978-957-8258
Practice Address - Street 1:1350 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3497
Practice Address - Country:US
Practice Address - Phone:978-957-5585
Practice Address - Fax:978-957-8258
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA35446OtherHPHC
MA0117046OtherAETNA
MAY35401OtherBCBS
MA713889OtherTUFTS
MAY35401Medicare ID - Type Unspecified
MAY35401OtherBCBS