Provider Demographics
NPI:1134266471
Name:BERGSTEIN, GARY T (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:BERGSTEIN
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 1:701 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3217
Mailing Address - Country:US
Mailing Address - Phone:412-781-4433
Mailing Address - Fax:412-781-9208
Practice Address - Street 1:701 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:PA
Practice Address - Zip Code:15215-3217
Practice Address - Country:US
Practice Address - Phone:412-781-4433
Practice Address - Fax:412-781-9208
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003337L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072811LPNMedicare ID - Type Unspecified
PAT28173Medicare UPIN