Provider Demographics
NPI:1255534038
Name:MATTIA, CELESTE ANNE (DC)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:ANNE
Last Name:MATTIA
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 1:752 JANE RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3409
Mailing Address - Country:US
Mailing Address - Phone:215-481-9355
Mailing Address - Fax:
Practice Address - Street 1:712 TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2148
Practice Address - Country:US
Practice Address - Phone:215-886-3773
Practice Address - Fax:215-886-3747
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006043L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0216809000Medicare UPIN
PAMA544699Medicare ID - Type Unspecified