Healthcare Provider Details

I. General information

NPI: 1417087743
Provider Name (Legal Business Name): KAREN ANN BERGMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 HAMPTON AVE
SAINT LOUIS MO
63109-2720
US

IV. Provider business mailing address

4717 HAMPTON AVE
SAINT LOUIS MO
63109-2720
US

V. Phone/Fax

Practice location:
  • Phone: 314-352-0834
  • Fax: 314-351-6411
Mailing address:
  • Phone: 314-352-0834
  • Fax: 314-351-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006780
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: