Healthcare Provider Details

I. General information

NPI: 1184994097
Provider Name (Legal Business Name): SERENA LEIGH ZAGST DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 KILSON DR SUITE 104
MOORESVILLE NC
28117-8217
US

IV. Provider business mailing address

111 KILSON DR SUITE 104
MOORESVILLE NC
28117-8217
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-5142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4235
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: