Provider Demographics
NPI:1992070940
Name:SHUM, CASSANDRA TRICIA (DC)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:TRICIA
Last Name:SHUM
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 1:323 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7403
Mailing Address - Country:US
Mailing Address - Phone:626-921-6819
Mailing Address - Fax:
Practice Address - Street 1:323 E FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7403
Practice Address - Country:US
Practice Address - Phone:626-921-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor