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General NPI Number Information
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NPI Number | 1982701637
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Entity Type | Organization
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Legal Business Name | BERGKAMP CHIROPRACTIC LLC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 11330 E CENTRAL AVE STE 500
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City | WICHITA
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State | KS
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Zip | 67206-2835
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Country | US
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Telephone | 316-682-6161
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Fax | 316-682-7650
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Provider Business Mailing Address
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Address Line | 11330 E CENTRAL AVE STE 500
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City | WICHITA
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State | KS
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Zip | 67206-2835
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Country | US
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Telephone | 316-682-6161
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Fax | 316-682-7650
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Authorized Official
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Title or Position | OWNER
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Name | DR. JILL SUZANNE BERGKAMP-ENGLE
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Credential | DC
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Telephone | 316-682-6161
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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 | 4762
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License Number State | KS
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