Provider Demographics
NPI:1619057445
Name:BADER, CASS JAYE (DC)
Entity type:Individual
Prefix:DR
First Name:CASS
Middle Name:JAYE
Last Name:BADER
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 1:20700 ECORSE ROAD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1962
Mailing Address - Country:US
Mailing Address - Phone:313-294-6000
Mailing Address - Fax:313-383-0419
Practice Address - Street 1:20700 ECORSE ROAD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1962
Practice Address - Country:US
Practice Address - Phone:313-294-6000
Practice Address - Fax:313-383-0419
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICB004392111N00000X
MI2301004392111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3481677Medicaid
6U0097OtherHAP
MI950Q250430OtherBCBS OF MI
350043386OtherPALMETTO GBA
6U0097OtherHAP