Provider Demographics
NPI:1649793837
Name:CANELO SERRANO, ANA G (DC)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:G
Last Name:CANELO SERRANO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FENWAY STE 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4016
Mailing Address - Country:US
Mailing Address - Phone:857-990-3721
Mailing Address - Fax:857-336-6878
Practice Address - Street 1:30 FENWAY STE 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-4016
Practice Address - Country:US
Practice Address - Phone:857-990-3721
Practice Address - Fax:857-336-6878
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13550111NR0400X
MACHI3837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACHI3837OtherMASSACHUSETTS CHIROPRACTIC LICENSE
MACHI3837OtherMASSACHUSETTS CHIROPRACTIC LICENSE