Provider Demographics
NPI:1366404956
Name:CASSANI, BRIAN T (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:CASSANI
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:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1547
Mailing Address - Country:US
Mailing Address - Phone:219-464-0103
Mailing Address - Fax:219-548-3828
Practice Address - Street 1:2600 N ROOSEVELT ROAD
Practice Address - Street 2:SUITE 100-2
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-0972
Practice Address - Country:US
Practice Address - Phone:219-464-0103
Practice Address - Fax:219-548-3828
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001122A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000347288OtherANTHEM BCBS PROVIDER NO
IN100148130BMedicaid
IN100148130BMedicaid
IN219320AMedicare ID - Type Unspecified