Provider Demographics
NPI:1992451561
Name:CECERE, PAUL THOMAS
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:CECERE
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 1:201 FOXTAIL DR APT F2
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6147
Mailing Address - Country:US
Mailing Address - Phone:201-615-8789
Mailing Address - Fax:
Practice Address - Street 1:201 FOXTAIL DR APT F2
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-6147
Practice Address - Country:US
Practice Address - Phone:201-615-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMP00957742OtherNCMIC