Provider Demographics
NPI:1083833370
Name:BERGTOLD, MATTHEW ROBERT (DC, BS,FIAMA)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:BERGTOLD
Suffix:
Gender:M
Credentials:DC, BS,FIAMA
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Mailing Address - Street 1:700 2ND AVE N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5756
Mailing Address - Country:US
Mailing Address - Phone:239-315-4694
Mailing Address - Fax:239-315-4696
Practice Address - Street 1:700 2ND AVE N
Practice Address - Street 2:STE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5701
Practice Address - Country:US
Practice Address - Phone:239-315-4694
Practice Address - Fax:239-315-4696
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH9083111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE733YMedicare UPIN