Healthcare Provider Details

I. General information

NPI: 1073683140
Provider Name (Legal Business Name): JESSICA SUZANNE BERGDEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 WARWICK AVE SUITE 102
WARWICK RI
02888-3657
US

IV. Provider business mailing address

1045 WARWICK AVE SUITE 102
WARWICK RI
02888-3657
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-2707
  • Fax: 401-461-2708
Mailing address:
  • Phone: 401-461-2707
  • Fax: 401-461-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC00417
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: