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General NPI Number Information
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NPI Number | 1205948601
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Entity Type | Organization
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Legal Business Name | PINE RIVER CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 175 S CLOVER DR SUITE 5
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City | BAYFIELD
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State | CO
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Zip | 81122-9651
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Country | US
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Telephone | 970-884-9779
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Fax | 970-884-0847
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Provider Business Mailing Address
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Address Line | PO BOX 1035 175 S CLOVER DR SUITE 5
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City | BAYFIELD
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State | CO
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Zip | 81122-9651
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Country | US
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Telephone | 970-884-9779
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Fax | 970-884-0847
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLINE BERGFALK
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Credential | DC
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Telephone | 970-884-9779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3573
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License Number State | CO
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