Provider Demographics
NPI:1689602419
Name:BERGREN, LEE ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANDREW
Last Name:BERGREN
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:PO BOX 1399
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692
Mailing Address - Country:US
Mailing Address - Phone:254-694-2010
Mailing Address - Fax:254-694-2015
Practice Address - Street 1:305 S BOSQUE
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692
Practice Address - Country:US
Practice Address - Phone:254-694-2010
Practice Address - Fax:254-694-2015
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX610324Medicare PIN
TXU08723Medicare UPIN