Provider Demographics
NPI:1023191897
Name:SARGENT, TIMOTHY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEE
Last Name:SARGENT
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:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41096-0211
Mailing Address - Country:US
Mailing Address - Phone:606-564-9900
Mailing Address - Fax:606-564-9901
Practice Address - Street 1:399 W MAPLE LEAF RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-9176
Practice Address - Country:US
Practice Address - Phone:606-564-9900
Practice Address - Fax:606-564-9907
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4537111N00000X
OH2331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003788Medicaid
6087201Medicare UPIN