Provider Demographics
NPI:1003899568
Name:CEJKA, EILEEN GERALYN (DC)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:GERALYN
Last Name:CEJKA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-1360
Mailing Address - Country:US
Mailing Address - Phone:978-897-8276
Mailing Address - Fax:978-897-8825
Practice Address - Street 1:1 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MAYNARD
Practice Address - State:MA
Practice Address - Zip Code:01754-1360
Practice Address - Country:US
Practice Address - Phone:978-897-8276
Practice Address - Fax:978-897-8825
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1601563Medicaid
MA352223OtherHARVARD PILGRIM HEALTHPLA
MA705036OtherTUFTS HEALTH PLAN
MA44-2000OtherUNITED HEALTHCARE
MAY35448OtherBLUE CROSS BLUE SHIELD ID
MA44-2000OtherUNITED HEALTHCARE
MA1601563Medicaid