Healthcare Provider Details

I. General information

NPI: 1417582081
Provider Name (Legal Business Name): TED CIBIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TED CIBIK PHD, ND, DMQ

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 LOVERS LEAP RD
LEECHBURG PA
15656-8836
US

IV. Provider business mailing address

825 LOVERS LEAP RD
LEECHBURG PA
15656-8836
US

V. Phone/Fax

Practice location:
  • Phone: 724-845-1041
  • Fax: 724-845-7739
Mailing address:
  • Phone: 724-845-1041
  • Fax: 724-845-7739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: