Provider Demographics
NPI:1215365101
Name:BERGEN, JONATHAN CALEB (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:CALEB
Last Name:BERGEN
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 1:215 E STATE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-2272
Mailing Address - Country:US
Mailing Address - Phone:616-232-6682
Mailing Address - Fax:616-215-1116
Practice Address - Street 1:215 E STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-2272
Practice Address - Country:US
Practice Address - Phone:616-232-6682
Practice Address - Fax:616-215-1116
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor