Provider Demographics
NPI:1568578268
Name:BERGSTROM, ERIC RICHARD (CHIROPRACTOR DC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:RICHARD
Last Name:BERGSTROM
Suffix:
Gender:M
Credentials:CHIROPRACTOR DC
Other - Prefix:
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Mailing Address - Street 1:820 S COUNTRY GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2635
Mailing Address - Country:US
Mailing Address - Phone:714-325-3839
Mailing Address - Fax:714-312-0073
Practice Address - Street 1:22222 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887
Practice Address - Country:US
Practice Address - Phone:714-692-7138
Practice Address - Fax:714-692-7141
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC22499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor