Provider Demographics
NPI:1962286963
Name:CUELLAR, CESAR VLADIMIR
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:VLADIMIR
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27638 SD HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-5527
Mailing Address - Country:US
Mailing Address - Phone:605-759-4948
Mailing Address - Fax:
Practice Address - Street 1:414 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2336
Practice Address - Country:US
Practice Address - Phone:217-342-7222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038014036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor