Mark A Cassellius, D.C.
Individual provider Active NPI Chiropractor · Onalaska, WI
NPI 1669433462 · NPPES record last updated Apr 26, 2011
Key facts
- NPI
- 1669433462
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2293 (WI)
- Practice address
- 419 Sand Lake Rd
Onalaska, WI 54650-2706 - Phone
- (608) 783-3307
- Fax
- (608) 779-9728
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2293 | WI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2293 | WI | Yes |
Addresses
Primary practice location
419 Sand Lake Rd
Onalaska, WI 54650-2706
Mailing address
419 Sand Lake Rd
Onalaska, WI 54650-2706
Phone (608) 783-3307
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38800700 | Medicaid | WI | |
| 350016946 | Other | WI | RR MEDICARE # |
Other providers in Onalaska, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.