Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 1068 | NE |
NPI | 1003901174 |
---|---|
Provider Name | Dr. David G Kassmeier |
First Address | Norfolk, NE 68701-2381 |
Second Address | Norfolk, NE 68701-2381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09613 | BLUE CROSS BLUE SHIELD (01) | |
47081337803 | (05) | NE |
47081337805 | (05) | NE |
9613 | BLUE CROSS BLUE SHIELD (01) | |
U43680 | (02) |