Provider Demographics
NPI:1902091929
Name:GERARD CASSISTA
Entity Type:Organization
Organization Name:GERARD CASSISTA
Other - Org Name:CASSISTA CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSISTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-957-5585
Mailing Address - Street 1:1350 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-3424
Mailing Address - Country:US
Mailing Address - Phone:978-957-5585
Mailing Address - Fax:978-957-8258
Practice Address - Street 1:1350 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-3497
Practice Address - Country:US
Practice Address - Phone:978-957-5585
Practice Address - Fax:978-957-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA553111N00000X
MA2889111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39094OtherBLUE CROSS BLUE SHIELD GR
T58155Medicare UPIN