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General NPI Number Information
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NPI Number | 1124185434
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Entity Type | Organization
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Legal Business Name | BERGEN FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 45 N LAKE AVE
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City | BERGEN
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State | NY
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Zip | 14416-9528
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Country | US
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Telephone | 585-494-2870
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Fax | 585-494-2260
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Provider Business Mailing Address
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Address Line | 45 N LAKE AVE PO BOX 606
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City | BERGEN
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State | NY
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Zip | 14416-9528
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Country | US
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Telephone | 585-494-2870
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Fax | 585-494-2260
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Authorized Official
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Title or Position | PROVIDER
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Name | AMY MERCOVICH
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Credential | D.C.
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Telephone | 585-494-2870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | X008349
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License Number State | NY
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