Provider Demographics
NPI:1114401270
Name:SERENA KLEINSTUB DC, P.C.
Entity Type:Organization
Organization Name:SERENA KLEINSTUB DC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:KLEINSTUB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:806-928-1858
Mailing Address - Street 1:21805 W FIELD PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3228
Mailing Address - Country:US
Mailing Address - Phone:224-848-6003
Mailing Address - Fax:224-848-6004
Practice Address - Street 1:21805 W FIELD PKWY STE 120
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-3228
Practice Address - Country:US
Practice Address - Phone:224-848-6003
Practice Address - Fax:224-848-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL067798OtherOPTUM
IL1193200OtherAMERICAN SPECIALTY HEALTH