Provider Demographics
NPI:1467552547
Name:SERRALTA, TADSERH SJEATOR (DC)
Entity Type:Individual
Prefix:DR
First Name:TADSERH
Middle Name:SJEATOR
Last Name:SERRALTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 US HIGHWAY 27 S
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-2173
Mailing Address - Country:US
Mailing Address - Phone:863-385-5300
Mailing Address - Fax:863-402-9147
Practice Address - Street 1:813 US HIGHWAY 27 S
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2173
Practice Address - Country:US
Practice Address - Phone:863-385-5300
Practice Address - Fax:863-402-9147
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380661801Medicaid
FL55215Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FL380661801Medicaid