Provider Demographics
NPI:1982862546
Name:CERESOLI CHIROPRACTIC PLC
Entity Type:Organization
Organization Name:CERESOLI CHIROPRACTIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERESOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-926-2622
Mailing Address - Street 1:745 W BASELINE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6020
Mailing Address - Country:US
Mailing Address - Phone:480-926-2622
Mailing Address - Fax:480-926-2989
Practice Address - Street 1:745 W BASELINE RD STE 20
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6020
Practice Address - Country:US
Practice Address - Phone:480-926-2622
Practice Address - Fax:480-926-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty