Provider Demographics
NPI:1053752535
Name:CASSANDRA PETERSON, DC, LLC
Entity type:Organization
Organization Name:CASSANDRA PETERSON, DC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:DARVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-399-1777
Mailing Address - Street 1:4348 WAIALAE AVE
Mailing Address - Street 2:PMB 247
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5767
Mailing Address - Country:US
Mailing Address - Phone:808-388-7682
Mailing Address - Fax:
Practice Address - Street 1:98-1277 KAAHUMANU ST
Practice Address - Street 2:SUITE 142A
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5314
Practice Address - Country:US
Practice Address - Phone:808-388-7682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty