Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 13971 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 13971 | CA |
NPI | 1194878561 |
---|---|
Provider Name | Dr. Ken Louis Cassorla |
First Address | Aptos, CA 95003-9592 |
Second Address | Santa Cruz, CA 95062-5232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |