Provider Demographics
NPI:1205042256
Name:CASSIDY, CHRISTINE E (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:E
Last Name:CASSIDY
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 1:130 S FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-6132
Mailing Address - Country:US
Mailing Address - Phone:408-523-1212
Mailing Address - Fax:408-523-1232
Practice Address - Street 1:130 S FRANCES ST
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-6132
Practice Address - Country:US
Practice Address - Phone:408-523-1212
Practice Address - Fax:408-523-1232
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05799Medicare UPIN