Provider Demographics
NPI:1710137740
Name:SEREKEBERHAN, EDEN BERHE (DC)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:BERHE
Last Name:SEREKEBERHAN
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 1:10607 REA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6524
Mailing Address - Country:US
Mailing Address - Phone:704-841-2504
Mailing Address - Fax:704-841-2508
Practice Address - Street 1:10607 REA RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6524
Practice Address - Country:US
Practice Address - Phone:704-841-2504
Practice Address - Fax:704-841-2508
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor