Provider Demographics
NPI:1083646285
Name:CEBEK CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CEBEK CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CEBEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-327-1220
Mailing Address - Street 1:4073 WILLIAM PENN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1807
Mailing Address - Country:US
Mailing Address - Phone:724-327-1220
Mailing Address - Fax:724-325-3351
Practice Address - Street 1:4073 WILLIAM PENN HIGHWAY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1807
Practice Address - Country:US
Practice Address - Phone:724-327-1220
Practice Address - Fax:724-325-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001794L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0709882Medicaid
T27091Medicare UPIN
PA021034Medicare ID - Type Unspecified