Provider Demographics
NPI:1760573323
Name:CASSIS, JEFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:CASSIS
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 1:1654 KRAMER ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4559
Mailing Address - Country:US
Mailing Address - Phone:304-549-4901
Mailing Address - Fax:
Practice Address - Street 1:3033 WILSON BLVD STE E-551
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-3866
Practice Address - Country:US
Practice Address - Phone:571-969-2333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0132197000Medicaid
WVCAO811701Medicare ID - Type Unspecified
WV0132197000Medicaid