Provider Demographics
NPI:1720116916
Name:SERPENTELLI, DANIEL J III (DC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:SERPENTELLI
Suffix:III
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 1:3806 MANATEE AVE WEST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205
Mailing Address - Country:US
Mailing Address - Phone:941-739-2225
Mailing Address - Fax:941-753-6821
Practice Address - Street 1:3806 MANATEE AVE WEST
Practice Address - Street 2:SUITE 100
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-739-2225
Practice Address - Fax:941-753-6821
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84288Medicare UPIN
FL22092ZMedicare ID - Type Unspecified