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General NPI Number Information
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NPI Number | 1417015942
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Entity Type | Organization
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Legal Business Name | CONTEMPORARY CHIROPRACTIC NEUROLOGY
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 566 WILBUR AVE
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City | SWANSEA
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State | MA
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Zip | 02777-2159
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Country | US
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Telephone | 508-672-0507
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Fax |
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Provider Business Mailing Address
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Address Line | 566 WILBUR AVE
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City | SWANSEA
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State | MA
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Zip | 02777-2159
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Country | US
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Telephone | 508-672-0507
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | FRANK BERGERON L BERGERON
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Credential | D.C.
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Telephone | 508-672-0507
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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 | 2007
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License Number State | MA
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