Provider Demographics
NPI:1003878117
Name:CERICOLA, L SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:L
Middle Name:SCOTT
Last Name:CERICOLA
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 1:508 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-3102
Mailing Address - Country:US
Mailing Address - Phone:610-866-0543
Mailing Address - Fax:610-867-9781
Practice Address - Street 1:508 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-3102
Practice Address - Country:US
Practice Address - Phone:610-866-0543
Practice Address - Fax:610-867-9781
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002489L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA197001OtherHIGHMARK BS
PA01718201OtherCAPITAL BLUE CROSS
PA4585839Medicaid
P2504816OtherOXFORD
PA4585839Medicaid