Provider Demographics
NPI:1124217807
Name:BERGMAN, JOHN ROY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROY
Last Name:BERGMAN
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 1:18582 BEACH BLVD
Mailing Address - Street 2:#22
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2000
Mailing Address - Country:US
Mailing Address - Phone:714-962-5891
Mailing Address - Fax:714-962-5820
Practice Address - Street 1:18582 BEACH BLVD
Practice Address - Street 2:#22
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2000
Practice Address - Country:US
Practice Address - Phone:714-962-5891
Practice Address - Fax:714-962-5820
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor