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General NPI Number Information
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NPI Number | 1326436064
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Entity Type | Individual
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Provider Name | ALYCEAN MARYRAE BERGH D.C.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 01/12/2024
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Provider Practice Location Address
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Address Line | 10950 CLUB WEST PKWY STE 190
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City | BLAINE
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State | MN
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Zip | 55449-4679
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Country | US
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Telephone | 763-400-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 10950 CLUB WEST PKWY STE 190
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City | BLAINE
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State | MN
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Zip | 55449-4679
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Country | US
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Telephone | 763-400-4940
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1076
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6018
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License Number State | MN
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