Provider Demographics
NPI:1255667069
Name:BERGERON CHIROPRACTIC
Entity Type:Organization
Organization Name:BERGERON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-437-2181
Mailing Address - Street 1:16 ROUTE 111
Mailing Address - Street 2:BLDG 2, UNIT 5
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4142
Mailing Address - Country:US
Mailing Address - Phone:603-437-2181
Mailing Address - Fax:
Practice Address - Street 1:16 ROUTE 111
Practice Address - Street 2:BLDG 2, UNIT 5
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4142
Practice Address - Country:US
Practice Address - Phone:603-734-2181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7040903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty