Healthcare Provider Details

I. General information

NPI: 1003899568
Provider Name (Legal Business Name): EILEEN GERALYN CEJKA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLEASANT ST
MAYNARD MA
01754-1360
US

IV. Provider business mailing address

1 PLEASANT ST
MAYNARD MA
01754-1360
US

V. Phone/Fax

Practice location:
  • Phone: 978-897-8276
  • Fax: 978-897-8825
Mailing address:
  • Phone: 978-897-8276
  • Fax: 978-897-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number648
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: