Provider Demographics
NPI:1609918721
Name:CASAZZA CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CASAZZA CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:CASAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-447-2200
Mailing Address - Street 1:2716 V ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1901
Mailing Address - Country:US
Mailing Address - Phone:916-447-2200
Mailing Address - Fax:916-447-7930
Practice Address - Street 1:2716 V ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1901
Practice Address - Country:US
Practice Address - Phone:916-447-2200
Practice Address - Fax:916-447-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28041111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU90466Medicare UPIN
CAZZZ23361ZMedicare ID - Type Unspecified