Provider Demographics
NPI:1942662267
Name:MUSCLE AND MOVEMENT THERAPY LLC
Entity Type:Organization
Organization Name:MUSCLE AND MOVEMENT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SERGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-546-4696
Mailing Address - Street 1:W62N228 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2763
Mailing Address - Country:US
Mailing Address - Phone:262-546-4696
Mailing Address - Fax:262-546-0757
Practice Address - Street 1:W62N228 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2763
Practice Address - Country:US
Practice Address - Phone:262-546-4696
Practice Address - Fax:262-546-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4802-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI106099862Medicaid