Healthcare Provider Details

I. General information

NPI: 1184996027
Provider Name (Legal Business Name): TADSERH SERRALTA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 US 27 S
SEBRING FL
33870-2173
US

IV. Provider business mailing address

813 US 27 S
SEBRING FL
33870-2173
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-5300
  • Fax: 863-402-9147
Mailing address:
  • Phone: 863-385-5300
  • Fax: 863-402-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0006802
License Number StateFL

VIII. Authorized Official

Name: MRS. LOURDES MARIA SERRALTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 863-385-5300