MEDICARE: DR. JOSE L SERRANO DC, DACBR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor	25506	CA

General Provider Information

NPI Number	:	1649392572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE L SERRANO DC, DACBR.

Provider Business Mailing Address
First Line	:	7872 RONALD DR # A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7110
Country	:	US
Telephone Number	:	714-791-2779
Fax Number	:	714-843-4958

Provider Business Practice Location Address
First Line	:	7872 RONALD DR # A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7110
Country	:	US
Telephone Number	:	714-791-2779
Fax Number	:	714-843-4958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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