Provider Demographics
NPI:1023118395
Name:DONOGHUE, KASSIE LYNNE (DC)
Entity type:Individual
Prefix:DR
First Name:KASSIE
Middle Name:LYNNE
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KASSIE
Other - Middle Name:LYNNE
Other - Last Name:SCHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:3908 J STREET,
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819
Mailing Address - Country:US
Mailing Address - Phone:916-451-5458
Mailing Address - Fax:916-451-5481
Practice Address - Street 1:3908 J STREET,
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819
Practice Address - Country:US
Practice Address - Phone:916-451-5458
Practice Address - Fax:916-451-5481
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC023105111N00000X
CADC0231050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023105Medicare ID - Type Unspecified
CADC0231050Medicare PIN
CAU53403Medicare UPIN
U53403Medicare UPIN