Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC002489L | PA |
NPI | 1003878117 |
---|---|
Provider Name | Dr. L Scott Cericola |
First Address | Bethlehem, PA 18018-3102 |
Second Address | Bethlehem, PA 18018-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01718201 | CAPITAL BLUE CROSS (01) | PA |
197001 | HIGHMARK BS (01) | PA |
4585839 | (05) | PA |
P2504816 | OXFORD (01) |