Provider Demographics
NPI:1801964762
Name:BERGHAUS, MARY GALE (DC)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:GALE
Last Name:BERGHAUS
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 1:7023 E 100TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6202
Mailing Address - Country:US
Mailing Address - Phone:918-298-2213
Mailing Address - Fax:918-298-1077
Practice Address - Street 1:7023 E 100TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6202
Practice Address - Country:US
Practice Address - Phone:918-298-2213
Practice Address - Fax:918-298-1077
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor