Provider Demographics
NPI:1609161819
Name:MAXIMENKO, CASSANDRA (DC, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:
Last Name:MAXIMENKO
Suffix:
Gender:F
Credentials:DC, MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 MAIN ST S
Mailing Address - Street 2:SUITE E
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4248
Mailing Address - Country:US
Mailing Address - Phone:203-267-3880
Mailing Address - Fax:203-267-3882
Practice Address - Street 1:760 MAIN ST S
Practice Address - Street 2:SUITE E
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4248
Practice Address - Country:US
Practice Address - Phone:203-267-3880
Practice Address - Fax:203-267-3882
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor