Provider Demographics
NPI:1376842500
Name:CASSITY, CARMEN (DC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CASSITY
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 1:13775 INTERURBAN AVE S APT D102
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5128
Mailing Address - Country:US
Mailing Address - Phone:563-528-4160
Mailing Address - Fax:
Practice Address - Street 1:13775 INTERURBAN AVE S APT D102
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-5128
Practice Address - Country:US
Practice Address - Phone:563-528-4160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2493111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor