MEDICARE: BERGERON CHIROPRACTIC NEUROLOGY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2007	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y39733	OTHER	MA	BLUE CROSS OF MA

General Provider Information

NPI Number	:	1053479212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGERON CHIROPRACTIC NEUROLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 431
Second Line	:
City	:	EAST FREETOWN
State	:	MA
Zip	:	02717-0431
Country	:	US
Telephone Number	:	508-763-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CROSSROADS DR
Second Line	:
City	:	EAST FREETOWN
State	:	MA
Zip	:	02717-1256
Country	:	US
Telephone Number	:	508-763-4450
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FRANK L BERGERON
Credential	:	DC
Telephone Number	:	508-763-4450

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/05/2013

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