Provider Demographics
NPI:1003977687
Name:CESARZ, STEFAN EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:EUGENE
Last Name:CESARZ
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 1:112 BANK ST
Mailing Address - Street 2:
Mailing Address - City:HARDINSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40143-2580
Mailing Address - Country:US
Mailing Address - Phone:270-756-1700
Mailing Address - Fax:270-756-6205
Practice Address - Street 1:112 BANK ST
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-2580
Practice Address - Country:US
Practice Address - Phone:270-756-1700
Practice Address - Fax:270-756-6205
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 4111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000602Medicaid
U43280Medicare UPIN
KY6066201Medicare ID - Type Unspecified