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General NPI Number Information
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NPI Number | 1891082210
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Entity Type | Organization
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Legal Business Name | SERENE OASIS CHIROPRACTIC AND ACUPUNCTURE PLLC
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 801 N MAIN ST SUITE C
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City | BOERNE
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State | TX
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Zip | 78006-1625
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Country | US
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Telephone | 830-331-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 801 N MAIN ST SUITE C
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City | BOERNE
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State | TX
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Zip | 78006-1625
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Country | US
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Telephone | 830-331-8600
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | KATHERINE VAN DYKE
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Credential | D.C.
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Telephone | 830-331-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11352
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License Number State | TX
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