Provider Demographics
NPI:1720100225
Name:CERECEDA, MARK ANTHONY (DC, PA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:CERECEDA
Suffix:
Gender:M
Credentials:DC, PA
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Mailing Address - Street 1:717 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE # 216
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2060
Mailing Address - Country:US
Mailing Address - Phone:305-441-9601
Mailing Address - Fax:305-441-9609
Practice Address - Street 1:207 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-6018
Practice Address - Country:US
Practice Address - Phone:305-246-0056
Practice Address - Fax:305-246-0093
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH 6867111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH 6867OtherCHIROPRACTIC PHYSICIAN LI