Provider Demographics
NPI:1124229851
Name:BERGMAN CHIROPRACTIC
Entity Type:Organization
Organization Name:BERGMAN CHIROPRACTIC
Other - Org Name:EMERGENCY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:918-665-2264
Mailing Address - Street 1:5610 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9040
Mailing Address - Country:US
Mailing Address - Phone:918-665-2264
Mailing Address - Fax:918-665-3691
Practice Address - Street 1:5610 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9040
Practice Address - Country:US
Practice Address - Phone:918-665-2264
Practice Address - Fax:918-665-3691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty