Healthcare Provider Details

I. General information

NPI: 1689602419
Provider Name (Legal Business Name): LEE ANDREW BERGREN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S BOSQUE
WHITNEY TX
76692
US

IV. Provider business mailing address

PO BOX 1399
WHITNEY TX
76692
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-2010
  • Fax: 254-694-2015
Mailing address:
  • Phone: 254-694-2010
  • Fax: 254-694-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9406
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: