Provider Demographics
NPI:1639521479
Name:BERGBOWER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BERGBOWER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BERGBOWER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-923-0100
Mailing Address - Street 1:100 W CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:IL
Mailing Address - Zip Code:62428-0825
Mailing Address - Country:US
Mailing Address - Phone:217-923-0100
Mailing Address - Fax:217-923-0201
Practice Address - Street 1:100 W CUMBERLAND ST.
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:IL
Practice Address - Zip Code:62428-0825
Practice Address - Country:US
Practice Address - Phone:217-923-0100
Practice Address - Fax:217-923-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty