Provider Demographics
NPI:1245470566
Name:PETERSON, CASSANDRA MAY (DC)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:MAY
Last Name:PETERSON
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 1:4348 WAIALAE AVE
Mailing Address - Street 2:PMB 247
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5767
Mailing Address - Country:US
Mailing Address - Phone:808-388-7682
Mailing Address - Fax:
Practice Address - Street 1:98-1277 KAAHUMANU ST
Practice Address - Street 2:SUITE 142A
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5314
Practice Address - Country:US
Practice Address - Phone:808-388-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor