1982701637 NPI number — BERGKAMP CHIROPRACTIC LLC

Table of content: (NPI 1982701637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982701637 NPI number — BERGKAMP CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BERGKAMP CHIROPRACTIC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BERGKAMP HART CHIROPRACTIC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982701637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11330 E CENTRAL AVE
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67206-2835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-682-6161
Provider Business Mailing Address Fax Number:
316-682-7650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11330 E CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67206-2835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-682-6161
Provider Business Practice Location Address Fax Number:
316-682-7650
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERGKAMP-ENGLE
Authorized Official First Name:
JILL
Authorized Official Middle Name:
SUZANNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
316-682-6161

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4762 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7590418 . This is a "AETNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 060939 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 141894 . This is a "COVENTRY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 14550 . This is a "PHS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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