Provider Demographics
NPI:1497875496
Name:BERGFALK, CAROLINE ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:BERGFALK
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:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9651
Mailing Address - Country:US
Mailing Address - Phone:970-884-9779
Mailing Address - Fax:970-884-0847
Practice Address - Street 1:175 S CLOVER LN
Practice Address - Street 2:SUITE 5
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122-9651
Practice Address - Country:US
Practice Address - Phone:970-884-9779
Practice Address - Fax:970-884-0847
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1652991OtherBLUE CROSS BLUE SHIELD
CO11653Medicare PIN
U43983Medicare UPIN