Provider Demographics
NPI:1316698012
Name:ANDERSON, CASSIDY MARIE (DC)
Entity type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CASSIDY
Other - Middle Name:MARIE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6324 E PACIFIC COAST HWY STE C
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4841
Mailing Address - Country:US
Mailing Address - Phone:562-493-5600
Mailing Address - Fax:
Practice Address - Street 1:6324 E PACIFIC COAST HWY STE C
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4841
Practice Address - Country:US
Practice Address - Phone:562-493-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36221111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician