Provider Demographics
NPI:1619037546
Name:ROBERTS, SERENA A (DC)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:A
Last Name:ROBERTS
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 1:4610 N GARFIELD ST
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2663
Mailing Address - Country:US
Mailing Address - Phone:432-687-4994
Mailing Address - Fax:432-683-8476
Practice Address - Street 1:4610 N GARFIELD ST
Practice Address - Street 2:SUITE B-5
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-2663
Practice Address - Country:US
Practice Address - Phone:432-687-4994
Practice Address - Fax:432-683-8476
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9038111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX608058Medicare UPIN