Healthcare Provider Details

I. General information

NPI: 1245050194
Provider Name (Legal Business Name): SERENITY FAMILY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 N AVONDALE AVE STE A108
CHICAGO IL
60631-1900
US

IV. Provider business mailing address

6321 N AVONDALE AVE STE A108
CHICAGO IL
60631-1900
US

V. Phone/Fax

Practice location:
  • Phone: 224-587-0129
  • Fax:
Mailing address:
  • Phone: 224-587-0129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: ERICA JURIS
Title or Position: MEMBER
Credential: DC
Phone: 224-587-0129