Provider Demographics
NPI:1821043670
Name:SERTELL, JENNIFER M (DC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:SERTELL
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 1:848 SCIOTO ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-2255
Mailing Address - Country:US
Mailing Address - Phone:937-484-3400
Mailing Address - Fax:
Practice Address - Street 1:848 SCIOTO ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-2255
Practice Address - Country:US
Practice Address - Phone:937-484-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSE4143133Medicare PIN