Provider Demographics
NPI:1447849617
Name:CASSEUS, KARL RICHARD (DC)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:RICHARD
Last Name:CASSEUS
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 1:1125 GEORGE URBAN BLVD APT 6-3
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-3877
Mailing Address - Country:US
Mailing Address - Phone:845-269-8686
Mailing Address - Fax:
Practice Address - Street 1:1796 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14206-3126
Practice Address - Country:US
Practice Address - Phone:845-269-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013415111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor