Provider Demographics
NPI:1619949096
Name:CASSIDY, DEBORAH MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:MARIE
Last Name:CASSIDY
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 1:113 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1234
Mailing Address - Country:US
Mailing Address - Phone:570-409-9500
Mailing Address - Fax:570-409-9505
Practice Address - Street 1:113 7TH ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1234
Practice Address - Country:US
Practice Address - Phone:570-409-9500
Practice Address - Fax:570-409-9505
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA006974-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00736308OtherBLUECROSS BLUE SHIELD
PA020774Medicare ID - Type Unspecified
PAU72536Medicare UPIN