MEDICARE: DR. MARTHA H BERGNER 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	5655	AZ

General Provider Information

NPI Number	:	1497758916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTHA H BERGNER D.C.

Provider Business Mailing Address
First Line	:	2330 N TUCSON BLVD
Second Line	:	SUITE 140
City	:	TUCSON
State	:	AZ
Zip	:	85716-2792
Country	:	US
Telephone Number	:	520-296-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 N TUCSON BLVD
Second Line	:	SUITE 140
City	:	TUCSON
State	:	AZ
Zip	:	85716-2792
Country	:	US
Telephone Number	:	520-296-5899
Fax Number	:

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	10/15/2007

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