Provider Demographics
NPI:1013962976
Name:BERGFORS, HEATHER LYN (DC)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYN
Last Name:BERGFORS
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 1:4742 42ND AVE SW
Mailing Address - Street 2:PMB #527
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4553
Mailing Address - Country:US
Mailing Address - Phone:206-914-3417
Mailing Address - Fax:
Practice Address - Street 1:2719 E MADISON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4752
Practice Address - Country:US
Practice Address - Phone:206-568-7545
Practice Address - Fax:206-568-8298
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM00034169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor