Provider Demographics
NPI:1598986887
Name:SERGY, DAVID REX
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:REX
Last Name:SERGY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W FLINT ST
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-1005
Mailing Address - Country:US
Mailing Address - Phone:810-653-5070
Mailing Address - Fax:810-653-5070
Practice Address - Street 1:519 W FLINT ST
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1005
Practice Address - Country:US
Practice Address - Phone:810-653-5070
Practice Address - Fax:810-653-5070
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B551420OtherBLUE CROSS BLUE SHIELD
MIP2UU78FOtherBLUE CARE NETWORK
MI0B551422352Medicare ID - Type Unspecified
MIU29895Medicare UPIN