Provider Demographics
NPI:1306847330
Name:CERNICKY, SHAWN GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:GREGORY
Last Name:CERNICKY
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 1:10339 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9293
Mailing Address - Country:US
Mailing Address - Phone:724-816-7777
Mailing Address - Fax:
Practice Address - Street 1:10339 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9293
Practice Address - Country:US
Practice Address - Phone:724-933-6262
Practice Address - Fax:724-933-6260
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006813L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017870880001Medicaid
PA722617WKPMedicare PIN