Provider Demographics
NPI:1104496769
Name:CERNY, ELIZABETH ROSE (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROSE
Last Name:CERNY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 N 84TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4863
Mailing Address - Country:US
Mailing Address - Phone:785-844-5448
Mailing Address - Fax:
Practice Address - Street 1:10200 W HAPPY VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2878
Practice Address - Country:US
Practice Address - Phone:623-432-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor