Provider Demographics
NPI:1497758916
Name:BERGNER, MARTHA H (DC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:H
Last Name:BERGNER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 N TUCSON BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-2792
Mailing Address - Country:US
Mailing Address - Phone:520-296-5899
Mailing Address - Fax:
Practice Address - Street 1:2330 N TUCSON BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2792
Practice Address - Country:US
Practice Address - Phone:520-296-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75753Medicare UPIN