Provider Demographics
NPI:1225589807
Name:KASSAB, OSAMA M (DC)
Entity type:Individual
Prefix:
First Name:OSAMA
Middle Name:M
Last Name:KASSAB
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 1:14566 DOMINO ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4066
Mailing Address - Country:US
Mailing Address - Phone:303-829-7483
Mailing Address - Fax:
Practice Address - Street 1:5690 DTC BLVD STE 140E
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111
Practice Address - Country:US
Practice Address - Phone:303-847-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2018-09-18
Deactivation Date:2018-07-26
Deactivation Code:
Reactivation Date:2018-09-11
Provider Licenses
StateLicense IDTaxonomies
COAT.00019132255A2300X
COCHR.0007709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer