Provider Demographics
NPI:1568986107
Name:BERGEN CHIROPRACTIC AND PERFORMANCE
Entity Type:Organization
Organization Name:BERGEN CHIROPRACTIC AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-796-7772
Mailing Address - Street 1:19-21 FAIR LAWN AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2337
Mailing Address - Country:US
Mailing Address - Phone:201-796-7772
Mailing Address - Fax:201-794-8818
Practice Address - Street 1:19-21 FAIR LAWN AVE STE 1C
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2337
Practice Address - Country:US
Practice Address - Phone:201-796-7772
Practice Address - Fax:201-794-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00746900111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty