Provider Demographics
NPI:1124883723
Name:SERENITY CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:SERENITY CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:406-613-7825
Mailing Address - Street 1:135 MILL TOWN LOOP STE C
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-5142
Mailing Address - Country:US
Mailing Address - Phone:406-613-7825
Mailing Address - Fax:
Practice Address - Street 1:135 MILL TOWN LOOP STE C
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5142
Practice Address - Country:US
Practice Address - Phone:406-613-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty