1043473630 NPI number — CECIL CHIROPRACTIC & REHABILITATION, PC

Table of content: (NPI 1043473630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043473630 NPI number — CECIL CHIROPRACTIC & REHABILITATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CECIL CHIROPRACTIC & REHABILITATION, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043473630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 MILLERS RUN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CECIL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15321-1264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-220-1800
Provider Business Mailing Address Fax Number:
412-220-2400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 MILLERS RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CECIL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15321-1264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-220-1800
Provider Business Practice Location Address Fax Number:
412-220-2400
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KHOURY
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
EDMUND
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
412-220-1800

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC006033L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 593331 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5641675 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 664743 . This is a "UNITED" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 715018 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 16698990002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201941 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7518611 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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