Provider Demographics
NPI:1710961388
Name:CERATO, EDWARD J (DC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:CERATO
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:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:WALNUTPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18088
Mailing Address - Country:US
Mailing Address - Phone:610-824-6339
Mailing Address - Fax:610-824-6778
Practice Address - Street 1:241 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1812
Practice Address - Country:US
Practice Address - Phone:610-824-6339
Practice Address - Fax:610-824-6778
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007361L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
50000908OtherCAPITAL BLUE CROSS ASHN
5898132OtherGHI
656087OtherUNITED HEALTHCARE
817251OtherFIRT PRIORITY HEALTH
1548105OtherPA BLUE SHIELD
P3617382OtherOXFORD HEALTH
656087OtherUNITED HEALTHCARE
PA039171Medicare ID - Type Unspecified