Provider Demographics
NPI:1053479212
Name:BERGERON CHIROPRACTIC NEUROLOGY PC
Entity Type:Organization
Organization Name:BERGERON CHIROPRACTIC NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-763-4450
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:EAST FREETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02717-0431
Mailing Address - Country:US
Mailing Address - Phone:508-763-4450
Mailing Address - Fax:
Practice Address - Street 1:8 CROSSROADS DR
Practice Address - Street 2:
Practice Address - City:EAST FREETOWN
Practice Address - State:MA
Practice Address - Zip Code:02717-1256
Practice Address - Country:US
Practice Address - Phone:508-763-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39733OtherBLUE CROSS OF MA
MAY49122Medicare ID - Type UnspecifiedMEDICARE