Provider Demographics
NPI:1831339522
Name:SERGENT, JEFFREY ADAM (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ADAM
Last Name:SERGENT
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:W62N228 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2763
Mailing Address - Country:US
Mailing Address - Phone:262-546-4696
Mailing Address - Fax:262-546-0757
Practice Address - Street 1:W62N228 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2763
Practice Address - Country:US
Practice Address - Phone:262-546-4696
Practice Address - Fax:262-546-0757
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4802-12111N00000X
MI2301009543111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100099862Medicaid