Provider Demographics
NPI:1669478509
Name:BERGKAMP-ENGLE, JILL S (DC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:S
Last Name:BERGKAMP-ENGLE
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 1:11330 E CENTRAL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2836
Mailing Address - Country:US
Mailing Address - Phone:316-682-6161
Mailing Address - Fax:316-682-7650
Practice Address - Street 1:11330 E CENTRAL AVE
Practice Address - Street 2:STE 500
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2836
Practice Address - Country:US
Practice Address - Phone:316-682-6161
Practice Address - Fax:316-682-7650
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS060939OtherBCBS
KS141894OtherCOVENTRY
KS14550OtherPREFERRED HEALTH SYSTEMS
KS7590418OtherAETNA
KS7590418OtherAETNA
KS14550OtherPREFERRED HEALTH SYSTEMS