Provider Demographics
NPI:1619513975
Name:BERGMAN, ZACHARY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:PAUL
Last Name:BERGMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 SW SIMPSON AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3599
Mailing Address - Country:US
Mailing Address - Phone:541-617-9771
Mailing Address - Fax:
Practice Address - Street 1:240 NW CLAYPOOL ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1842
Practice Address - Country:US
Practice Address - Phone:541-447-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor