Provider Demographics
NPI:1215970587
Name:CECCARELLI, HARRIETTA (DC)
Entity type:Individual
Prefix:DR
First Name:HARRIETTA
Middle Name:
Last Name:CECCARELLI
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 1:2250 GULF GATE DR
Mailing Address - Street 2:SUITE H&B
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-4838
Mailing Address - Country:US
Mailing Address - Phone:786-457-2225
Mailing Address - Fax:
Practice Address - Street 1:2250 GULF GATE DR
Practice Address - Street 2:SUITE H&B
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-4838
Practice Address - Country:US
Practice Address - Phone:786-457-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381659100Medicaid
FL88105AOtherBC/BS
FL88105AMedicare ID - Type Unspecified
FL381659100Medicaid