Provider Demographics
NPI:1225916547
Name:SERRANO, EDGAR (DC)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:SERRANO
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 1:1150 S BASCOM AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3509
Mailing Address - Country:US
Mailing Address - Phone:650-464-0909
Mailing Address - Fax:
Practice Address - Street 1:1150 S BASCOM AVE STE 17
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3509
Practice Address - Country:US
Practice Address - Phone:650-464-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor