Provider Demographics
NPI:1609909340
Name:CEJ, MARIO VALENTINO (CHIROPRACTOR)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:VALENTINO
Last Name:CEJ
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8869 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5355
Mailing Address - Country:US
Mailing Address - Phone:412-367-4325
Mailing Address - Fax:
Practice Address - Street 1:550 CAMP HORNE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-369-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005098L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACE476075Medicare UPIN