Provider Demographics
NPI:1366633323
Name:CASSITY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:CASSITY CHIROPRACTIC CENTER LLC
Other - Org Name:VERNIE J. CASSITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER, CHIROPRACTIC ASS.
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CASSITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-787-8309
Mailing Address - Street 1:2111 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4048
Mailing Address - Country:US
Mailing Address - Phone:517-787-8309
Mailing Address - Fax:517-787-8409
Practice Address - Street 1:2111 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4048
Practice Address - Country:US
Practice Address - Phone:517-787-8309
Practice Address - Fax:517-787-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP24270001OtherMEDICARE PLUS BLUE
MI0P24270Medicare Oscar/Certification
MIY45032Medicare UPIN
MI0001Medicare PIN