Healthcare Provider Details

I. General information

NPI: 1205948601
Provider Name (Legal Business Name): PINE RIVER CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S CLOVER DR SUITE 5
BAYFIELD CO
81122-9651
US

IV. Provider business mailing address

PO BOX 1035 175 S CLOVER DR SUITE 5
BAYFIELD CO
81122-9651
US

V. Phone/Fax

Practice location:
  • Phone: 970-884-9779
  • Fax: 970-884-0847
Mailing address:
  • Phone: 970-884-9779
  • Fax: 970-884-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3573
License Number StateCO

VIII. Authorized Official

Name: DR. CAROLINE BERGFALK
Title or Position: OWNER
Credential: DC
Phone: 970-884-9779