Provider Demographics
NPI:1881892636
Name:ADVANCED HEALTH
Entity type:Organization
Organization Name:ADVANCED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-362-2300
Mailing Address - Street 1:401 S PELHAM ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3314
Mailing Address - Country:US
Mailing Address - Phone:715-362-2300
Mailing Address - Fax:
Practice Address - Street 1:401 S PELHAM ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3314
Practice Address - Country:US
Practice Address - Phone:715-362-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3888-012111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38942000Medicaid
WI38942100Medicaid
WI38942000Medicaid
WI000235461Medicare ID - Type Unspecified
WI38942100Medicaid
WI000135461Medicare ID - Type Unspecified