Provider Demographics
NPI:1821235318
Name:BERTHOLF, KASSANDRA MARIE (DC)
Entity Type:Individual
Prefix:MRS
First Name:KASSANDRA
Middle Name:MARIE
Last Name:BERTHOLF
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:KASSANDRA
Other - Middle Name:MARIE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 1752
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-1752
Mailing Address - Country:US
Mailing Address - Phone:308-534-5840
Mailing Address - Fax:308-534-1531
Practice Address - Street 1:1717 EAST 4TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-4392
Practice Address - Country:US
Practice Address - Phone:308-534-5840
Practice Address - Fax:308-534-1531
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1345001Medicare PIN