Provider Demographics
NPI:1467658203
Name:SERACK, CHANTEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANTEL
Middle Name:
Last Name:SERACK
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 1:8218 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1654
Mailing Address - Country:US
Mailing Address - Phone:952-835-4424
Mailing Address - Fax:
Practice Address - Street 1:13911 RIDGEDALE DR STE 255
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1773
Practice Address - Country:US
Practice Address - Phone:952-545-3839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4921111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor