Provider Demographics
NPI:1578595781
Name:CEBEK, GARY JOHN (D C)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JOHN
Last Name:CEBEK
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001794L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0709882Medicaid
T27091Medicare UPIN
PA0709882Medicaid