Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC 010744 | PA |
N | 111N00000X | Chiropractor | DC 30986 | CA |
NPI | 1003119397 |
---|---|
Provider Name | Dr. Tammy Kay Cassa |
First Address | Erie, PA 16509-1369 |
Second Address | Erie, PA 16509-1369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2010 |
Last Update Date | 07/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340459 | MEDICARE PTAN (01) | PA |