Provider Demographics
NPI:1982701637
Name:BERGKAMP CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BERGKAMP CHIROPRACTIC LLC
Other - Org Name:BERGKAMP HART CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:BERGKAMP-ENGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:316-682-6161
Mailing Address - Street 1:11330 E CENTRAL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-2835
Mailing Address - Country:US
Mailing Address - Phone:316-682-6161
Mailing Address - Fax:316-682-7650
Practice Address - Street 1:11330 E CENTRAL AVE
Practice Address - Street 2:STE 500
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2835
Practice Address - Country:US
Practice Address - Phone:316-682-6161
Practice Address - Fax:316-682-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4762111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7590418OtherAETNA
KS060939OtherBCBS
KS141894OtherCOVENTRY
KS14550OtherPHS
KS14550OtherPHS
KSU91563Medicare UPIN