Provider Demographics
NPI:1588759088
Name:SERENA, BRYAN D (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:D
Last Name:SERENA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HAMILTON CHIROPRACTIC
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570
Mailing Address - Country:US
Mailing Address - Phone:205-921-5700
Mailing Address - Fax:205-921-5701
Practice Address - Street 1:1925 MILITARY ST S.
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570
Practice Address - Country:US
Practice Address - Phone:205-921-5700
Practice Address - Fax:205-921-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU88996Medicare UPIN