Provider Demographics
NPI:1972171353
Name:SERNA, NICOLAS (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:SERNA
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2771
Mailing Address - Country:US
Mailing Address - Phone:862-205-4847
Mailing Address - Fax:973-201-1192
Practice Address - Street 1:26 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2771
Practice Address - Country:US
Practice Address - Phone:862-205-4847
Practice Address - Fax:973-201-1192
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00783500111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00783500OtherOUT OF NETWORK CHIROPRACTIC