Provider Demographics
NPI:1619792959
Name:CEDAR CREST CHIROPRACTIC LLC
Entity type:Organization
Organization Name:CEDAR CREST CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PETRILAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:610-776-2005
Mailing Address - Street 1:1028 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5444
Mailing Address - Country:US
Mailing Address - Phone:610-776-2005
Mailing Address - Fax:610-776-1475
Practice Address - Street 1:1028 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-5444
Practice Address - Country:US
Practice Address - Phone:610-776-2005
Practice Address - Fax:610-776-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty