Provider Demographics
NPI:1265532501
Name:BERGTOLD, JAMES JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:BERGTOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3000 IMMOKALEE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1444
Mailing Address - Country:US
Mailing Address - Phone:239-593-6788
Mailing Address - Fax:239-593-6799
Practice Address - Street 1:3000 IMMOKALEE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1444
Practice Address - Country:US
Practice Address - Phone:239-593-6788
Practice Address - Fax:239-593-6799
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLCH7760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030397688OtherTAX ID
FL350051002OtherRAILROAD
FL381203100Medicaid
FL55882OtherBLUE CROSS BLUE SHIELD
FL350051002OtherRAILROAD
FL55882Medicare ID - Type Unspecified