MEDICARE: BERGEN FAMILY CHIROPRACTIC

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	261QM2500X	Medical Specialty Clinic/Center	X008349	NY

General Provider Information

NPI Number	:	1124185434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGEN FAMILY CHIROPRACTIC

Provider Business Mailing Address
First Line	:	45 N LAKE AVE
Second Line	:	PO BOX 606
City	:	BERGEN
State	:	NY
Zip	:	14416-9528
Country	:	US
Telephone Number	:	585-494-2870
Fax Number	:	585-494-2260

Provider Business Practice Location Address
First Line	:	45 N LAKE AVE
Second Line	:
City	:	BERGEN
State	:	NY
Zip	:	14416-9528
Country	:	US
Telephone Number	:	585-494-2870
Fax Number	:	585-494-2260

Authorized Official
Title or Position	:	PROVIDER
Name	:	AMY MERCOVICH
Credential	:	D.C.
Telephone Number	:	585-494-2870

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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