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General NPI Number Information
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NPI Number | 1578586087
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Entity Type | Individual
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Provider Name | SHAWN J BERGMAN D.C.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8620 E 32ND CT N
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City | WICHITA
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State | KS
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Zip | 67226-4007
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Country | US
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Telephone | 316-612-0600
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Fax | 316-612-1140
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Provider Business Mailing Address
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Address Line | 7610 E 32ND ST N #108
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City | WICHITA
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State | KS
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Zip | 67226-1279
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Country | US
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Telephone | 913-340-0814
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0105016
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License Number State | KS
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