Provider Demographics
NPI:1417908120
Name:SARGENT, ELAINE KAY (DC)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:KAY
Last Name:SARGENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:KAY
Other - Last Name:BOLTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:7360 CREIGHTON PKWY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4513
Mailing Address - Country:US
Mailing Address - Phone:804-559-6818
Mailing Address - Fax:
Practice Address - Street 1:7360 CREIGHTON PKWY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4513
Practice Address - Country:US
Practice Address - Phone:804-559-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001928111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001155Medicare ID - Type Unspecified
VAU84766Medicare UPIN