Provider Demographics
NPI:1215925383
Name:CASS, STAUSH OAK (DC)
Entity type:Individual
Prefix:MR
First Name:STAUSH
Middle Name:OAK
Last Name:CASS
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 1:1245 GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-8958
Mailing Address - Country:US
Mailing Address - Phone:330-674-0444
Mailing Address - Fax:330-674-0802
Practice Address - Street 1:1245 GLEN DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8958
Practice Address - Country:US
Practice Address - Phone:330-674-0444
Practice Address - Fax:330-674-0802
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0937188Medicaid
0748956Medicare ID - Type Unspecified
U48542Medicare UPIN