Provider Demographics
NPI:1649200254
Name:CECIL, BRYAN E (DC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:E
Last Name:CECIL
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 1:1553 NILES CORTLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484
Mailing Address - Country:US
Mailing Address - Phone:330-505-3515
Mailing Address - Fax:330-505-3552
Practice Address - Street 1:1553 NILES CORTLAND ROAD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-505-3515
Practice Address - Fax:330-505-3552
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080804Medicaid
OHCH9354831Medicare ID - Type Unspecified
OH2080804Medicaid