Provider Demographics
NPI:1043473630
Name:CECIL CHIROPRACTIC & REHABILITATION, PC
Entity type:Organization
Organization Name:CECIL CHIROPRACTIC & REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACRB
Authorized Official - Phone:412-220-1800
Mailing Address - Street 1:3131 MILLERS RUN RD
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:PA
Mailing Address - Zip Code:15321-1264
Mailing Address - Country:US
Mailing Address - Phone:412-220-1800
Mailing Address - Fax:412-220-2400
Practice Address - Street 1:3131 MILLERS RUN RD
Practice Address - Street 2:
Practice Address - City:CECIL
Practice Address - State:PA
Practice Address - Zip Code:15321-1264
Practice Address - Country:US
Practice Address - Phone:412-220-1800
Practice Address - Fax:412-220-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006033L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA593331OtherHEALTH ASSURANCE
PA5641675OtherAETNA
PA664743OtherUNITED
PA715018OtherBLUE CROSS BLUE SHIELD
PA16698990002Medicaid
PA201941OtherUPMC
PA7518611OtherCIGNA
PA5641675OtherAETNA