Provider Demographics
NPI:1871056382
Name:SERRANO, JACQUELINE EVAMARIE (DC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:EVAMARIE
Last Name:SERRANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:EVAMARIE
Other - Last Name:VEKICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:102 VIA PESEDA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673
Mailing Address - Country:US
Mailing Address - Phone:619-995-5922
Mailing Address - Fax:949-627-8110
Practice Address - Street 1:28062 FORBES ROAD
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-345-1160
Practice Address - Fax:949-627-8110
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34480111N00000X
CADC34480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor