Provider Demographics
NPI:1801905591
Name:CASSARA, JOHN C (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CASSARA
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 1:1455 WEST 38TH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508
Mailing Address - Country:US
Mailing Address - Phone:814-860-3324
Mailing Address - Fax:814-864-3334
Practice Address - Street 1:1455 WEST 38TH
Practice Address - Street 2:SUITE 1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-860-3324
Practice Address - Fax:814-864-3334
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73890Medicare UPIN
PA022315Medicare ID - Type Unspecified