Provider Demographics
NPI:1932478203
Name:KASSUBE, ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:KASSUBE
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 1:13761 W BELL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2453
Mailing Address - Country:US
Mailing Address - Phone:623-214-7600
Mailing Address - Fax:623-214-7662
Practice Address - Street 1:13761 W BELL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2453
Practice Address - Country:US
Practice Address - Phone:623-214-7600
Practice Address - Fax:623-214-7662
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8243111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner