Provider Demographics
NPI:1053486480
Name:BERGAMINI, PAUL W (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:BERGAMINI
Suffix:
Gender:M
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:PO BOX 1403
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414
Mailing Address - Country:US
Mailing Address - Phone:307-587-7060
Mailing Address - Fax:
Practice Address - Street 1:1543 BLEISTEIN AVENUE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-587-4600
Practice Address - Fax:307-527-6949
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY614111N00000X
CO1220111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY9908Medicare ID - Type Unspecified
T60428Medicare UPIN