Provider Demographics
NPI:1689721995
Name:BERGLUND, DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:BERGLUND
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 1:66 GLENBROOK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8402
Mailing Address - Country:US
Mailing Address - Phone:203-978-1100
Mailing Address - Fax:
Practice Address - Street 1:66 GLENBROOK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8402
Practice Address - Country:US
Practice Address - Phone:203-978-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP405271OtherOXFORD HEALTH INSURANCE
CT050000702CT01OtherBLUECROSS BLUESHIELD