Provider Demographics
NPI:1639761562
Name:SUPER, CASANDRA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:CASANDRA
Middle Name:LEIGH
Last Name:SUPER
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 1:2 LEES LN
Mailing Address - Street 2:
Mailing Address - City:HADDON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1091
Mailing Address - Country:US
Mailing Address - Phone:856-858-5511
Mailing Address - Fax:856-858-5511
Practice Address - Street 1:2 LEES LN
Practice Address - Street 2:
Practice Address - City:HADDON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08107-1091
Practice Address - Country:US
Practice Address - Phone:856-858-5511
Practice Address - Fax:856-858-5511
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00780900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor