Healthcare Provider Details

I. General information

NPI: 1477099265
Provider Name (Legal Business Name): CHAD ANDREW CEKUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CROWN POINT CIR
GRASS VALLEY CA
95945-9561
US

IV. Provider business mailing address

500 CROWN POINT CIR STE 100
GRASS VALLEY CA
95945-9561
US

V. Phone/Fax

Practice location:
  • Phone: 530-273-5440
  • Fax:
Mailing address:
  • Phone: 530-273-5440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: