Provider Demographics
NPI:1558319939
Name:CERUTTI, JOHN FREDERICK (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:CERUTTI
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 1:545 BROAD AVE
Mailing Address - Street 2:P. O. BOX 167
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1607
Mailing Address - Country:US
Mailing Address - Phone:201-585-0277
Mailing Address - Fax:201-585-0943
Practice Address - Street 1:545 BROAD AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1607
Practice Address - Country:US
Practice Address - Phone:201-585-0277
Practice Address - Fax:201-585-0943
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00219600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44837Medicare UPIN
NJCE184618Medicare ID - Type Unspecified