Healthcare Provider Details

I. General information

NPI: 1982701520
Provider Name (Legal Business Name): ANTHONY SERLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10752 DEERWOOD PARK BLVD SUITE 100
JACKSONVILLE FL
32256-4849
US

IV. Provider business mailing address

10752 DEERWOOD PARK BLVD SUITE 100
JACKSONVILLE FL
32256-4849
US

V. Phone/Fax

Practice location:
  • Phone: 904-814-8417
  • Fax: 904-385-3908
Mailing address:
  • Phone: 904-814-8417
  • Fax: 904-385-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH9887
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberMC005560NJ
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: