Provider Demographics
NPI:1023203163
Name:CERASUOLO ENTERPRISES, INC
Entity Type:Organization
Organization Name:CERASUOLO ENTERPRISES, INC
Other - Org Name:ADVANTAGE CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:CERASUOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-357-8940
Mailing Address - Street 1:221 BOSTON POST RD E
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3527
Mailing Address - Country:US
Mailing Address - Phone:508-357-8940
Mailing Address - Fax:
Practice Address - Street 1:221 BOSTON POST RD E
Practice Address - Street 2:SUITE 125
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3527
Practice Address - Country:US
Practice Address - Phone:508-357-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU77971Medicare UPIN