Provider Demographics
NPI:1508154972
Name:CASS, PAULETTE (DC)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:CASS
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 1:88 BELVEDERE ST STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-7202
Mailing Address - Country:US
Mailing Address - Phone:415-209-4757
Mailing Address - Fax:
Practice Address - Street 1:88 BELVEDERE ST STE 208
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-7202
Practice Address - Country:US
Practice Address - Phone:415-259-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 26272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor