Provider Demographics
NPI:1083277164
Name:CASSELMAN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CASSELMAN CHIROPRACTIC PC
Other - Org Name:HARBOR FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:CASSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-681-3090
Mailing Address - Street 1:2141 CASS LAKE RD STE 101102
Mailing Address - Street 2:
Mailing Address - City:KEEGO HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48320-1270
Mailing Address - Country:US
Mailing Address - Phone:248-681-3090
Mailing Address - Fax:248-681-3891
Practice Address - Street 1:2141 CASS LAKE RD STE 101102
Practice Address - Street 2:
Practice Address - City:KEEGO HARBOR
Practice Address - State:MI
Practice Address - Zip Code:48320-1270
Practice Address - Country:US
Practice Address - Phone:248-681-3090
Practice Address - Fax:248-681-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1205218583OtherNATIONAL PROVIDER NUMBER