Provider Demographics
NPI:1184954968
Name:CESTARO CHIROPRACTIC PC
Entity type:Organization
Organization Name:CESTARO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CESTARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-458-0840
Mailing Address - Street 1:5620 BUSINESS AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-9576
Mailing Address - Country:US
Mailing Address - Phone:315-458-0840
Mailing Address - Fax:315-458-0777
Practice Address - Street 1:5620 BUSINESS AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-9576
Practice Address - Country:US
Practice Address - Phone:315-458-0840
Practice Address - Fax:315-458-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011326-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty