Provider Demographics
NPI:1699250811
Name:ANCIRA, SERENDIPITY R (LMT)
Entity type:Individual
Prefix:
First Name:SERENDIPITY
Middle Name:R
Last Name:ANCIRA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 EASTLAKE AVE E STE 360
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3143
Mailing Address - Country:US
Mailing Address - Phone:206-324-8600
Mailing Address - Fax:206-322-8520
Practice Address - Street 1:2722 EASTLAKE AVE E STE 360
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3143
Practice Address - Country:US
Practice Address - Phone:206-324-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60854043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911805909OtherEASTLAKE CHIROPRACTIC CTR, PS