Provider Demographics
NPI:1588624233
Name:KASSALIAS, ALEXANDER (DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:KASSALIAS
Suffix:
Gender:M
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:PO BOX 26807
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-1807
Mailing Address - Country:US
Mailing Address - Phone:864-297-3000
Mailing Address - Fax:
Practice Address - Street 1:701 CONGAREE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3519
Practice Address - Country:US
Practice Address - Phone:864-297-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1915Medicaid
SCCH1915Medicaid
SCU66949Medicare UPIN