Provider Demographics
NPI:1215021449
Name:BERGTOLD CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:BERGTOLD CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGTOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-593-6788
Mailing Address - Street 1:3000 IMMOKALEE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1444
Mailing Address - Country:US
Mailing Address - Phone:239-593-6788
Mailing Address - Fax:239-593-6799
Practice Address - Street 1:3000 IMMOKALEE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1444
Practice Address - Country:US
Practice Address - Phone:239-593-6788
Practice Address - Fax:239-593-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55882Medicare ID - Type Unspecified