Provider Demographics
NPI:1710180161
Name:BERGSTEIN, DAVID J (CMT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BERGSTEIN
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 PEARL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4668
Mailing Address - Country:US
Mailing Address - Phone:303-527-0882
Mailing Address - Fax:303-530-4440
Practice Address - Street 1:2299 PEARL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4668
Practice Address - Country:US
Practice Address - Phone:303-527-0882
Practice Address - Fax:303-530-4440
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist