Provider Demographics
NPI:1235247693
Name:BERGLUND, MICHAEL DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:BERGLUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5027 GREEN BAY RD
Mailing Address - Street 2:STE 118
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:262-925-8600
Mailing Address - Fax:292-925-8599
Practice Address - Street 1:5027 GREEN BAY RD
Practice Address - Street 2:STE 118
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-925-8600
Practice Address - Fax:292-925-8599
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI2671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI19800Medicare UPIN