Provider Demographics
NPI:1952673964
Name:DR. SERENA, PC
Entity Type:Organization
Organization Name:DR. SERENA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:ZAGST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-224-8088
Mailing Address - Street 1:111 KILSON DR
Mailing Address - Street 2:STE. 104
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8217
Mailing Address - Country:US
Mailing Address - Phone:704-663-5142
Mailing Address - Fax:
Practice Address - Street 1:111 KILSON DR
Practice Address - Street 2:STE. 104
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8217
Practice Address - Country:US
Practice Address - Phone:704-663-5142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4235111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty