Provider Demographics
NPI:1154182004
Name:CANTU, CASSANDRA ROSE (DC)
Entity type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:ROSE
Last Name:CANTU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-6625
Mailing Address - Country:US
Mailing Address - Phone:636-978-5511
Mailing Address - Fax:888-351-2941
Practice Address - Street 1:2530 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-6625
Practice Address - Country:US
Practice Address - Phone:636-978-5511
Practice Address - Fax:888-351-2941
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024001508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor