Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 8243 | AZ |
N | 111NI0013X | Independent Medical Examiner | 8243 | AZ |
NPI | 1932478203 |
---|---|
Provider Name | Anthony Kassube |
First Address | Surprise, AZ 85374-2453 |
Second Address | Surprise, AZ 85374-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2011 |
Last Update Date | 23/05/2013 |