MEDICARE: DR. HEATHER LYN BERGFORS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CM00034169	WA

General Provider Information

NPI Number	:	1013962976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER LYN BERGFORS D.C.

Provider Business Mailing Address
First Line	:	4742 42ND AVE SW
Second Line	:	PMB #527
City	:	SEATTLE
State	:	WA
Zip	:	98116-4553
Country	:	US
Telephone Number	:	206-914-3417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2719 E MADISON ST
Second Line	:	SUITE 203
City	:	SEATTLE
State	:	WA
Zip	:	98112-4752
Country	:	US
Telephone Number	:	206-568-7545
Fax Number	:	206-568-8298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	09/11/2009

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