Provider Demographics
NPI:1124185434
Name:BERGEN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:BERGEN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-494-2870
Mailing Address - Street 1:45 N LAKE AVE
Mailing Address - Street 2:PO BOX 606
Mailing Address - City:BERGEN
Mailing Address - State:NY
Mailing Address - Zip Code:14416-9528
Mailing Address - Country:US
Mailing Address - Phone:585-494-2870
Mailing Address - Fax:585-494-2260
Practice Address - Street 1:45 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:BERGEN
Practice Address - State:NY
Practice Address - Zip Code:14416-9528
Practice Address - Country:US
Practice Address - Phone:585-494-2870
Practice Address - Fax:585-494-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008349261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID
NY=========OtherTAX ID