Provider Demographics
NPI:1033166707
Name:SERGE, GREGORY J (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:SERGE
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 1:1101 TWIN C LN STE 201
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2159
Mailing Address - Country:US
Mailing Address - Phone:302-892-9355
Mailing Address - Fax:302-892-3494
Practice Address - Street 1:1101 TWIN C LN STE 201
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2159
Practice Address - Country:US
Practice Address - Phone:302-892-9355
Practice Address - Fax:302-892-3494
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007651L111N00000X
DEFI0000471111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U78073Medicare UPIN
U78073Medicare UPIN