Provider Demographics
NPI:1821196957
Name:BJERKNESS, SCOTT LEROY (DC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEROY
Last Name:BJERKNESS
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 1:34 COURT STREET
Mailing Address - Street 2:PO BOX 2086
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28771
Mailing Address - Country:US
Mailing Address - Phone:828-479-9000
Mailing Address - Fax:828-479-9002
Practice Address - Street 1:34 COURT STREET
Practice Address - Street 2:FREEDOM CHIROPRACTIC CLINIC
Practice Address - City:ROBBINSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28771
Practice Address - Country:US
Practice Address - Phone:828-479-9000
Practice Address - Fax:828-479-9002
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085HYMedicaid
NC085HYOtherBCBS
NC2455237AMedicare ID - Type Unspecified
NC89085HYMedicaid