Healthcare Provider Details

I. General information

NPI: 1538224118
Provider Name (Legal Business Name): JEFFREY K . BERGIN, DC, DABCI, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 SHERIDAN RD SUITE 1A
ZION IL
60099-2629
US

IV. Provider business mailing address

2629 SHERIDAN RD SUITE 1A
ZION IL
60099-2629
US

V. Phone/Fax

Practice location:
  • Phone: 847-872-8230
  • Fax: 847-872-8208
Mailing address:
  • Phone: 847-872-8230
  • Fax: 847-872-8208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number038-004780
License Number StateIL

VIII. Authorized Official

Name: DR. JEFFREY KEITH BERGIN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 847-872-8230