Provider Demographics
NPI:1710297932
Name:KLEINSTUB, SERENA (DC)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:
Last Name:KLEINSTUB
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 1:21805 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
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11591111N00000X
IL038012056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL067798OtherOPTUM
IL1193200OtherAMERICAN SPECIALTY HEALTH
IL537465489OtherBCBS