Provider Demographics
NPI:1982172037
Name:KAAS, KASSANDRA KAYE (DC)
Entity Type:Individual
Prefix:
First Name:KASSANDRA
Middle Name:KAYE
Last Name:KAAS
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 1:500 LINDEN ST # 5
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-3073
Mailing Address - Country:US
Mailing Address - Phone:218-393-2215
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 490
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1772
Practice Address - Country:US
Practice Address - Phone:952-417-6316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6343111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor