Provider Demographics
NPI:1083233068
Name:HERVAT, EMMA JEANETTE (DC)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:JEANETTE
Last Name:HERVAT
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 1:820 GENEVA PKWY N
Mailing Address - Street 2:STE 105
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-4562
Mailing Address - Country:US
Mailing Address - Phone:262-248-6700
Mailing Address - Fax:262-486-6764
Practice Address - Street 1:820 GENEVA PKWY N UNIT 105
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-4562
Practice Address - Country:US
Practice Address - Phone:262-248-6700
Practice Address - Fax:262-248-6764
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5534-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor