MEDICARE: LORI ANDREIS BERGERON

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	DC21624	CA
2	111N00000X	Chiropractor	DC21875	CA

General Provider Information

NPI Number	:	1104038777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORI ANDREIS BERGERON

Provider Business Mailing Address
First Line	:	1640 TIBURON BLVD
Second Line	:	6
City	:	TIBURON
State	:	CA
Zip	:	94920-2515
Country	:	US
Telephone Number	:	415-435-7420
Fax Number	:	415-435-7424

Provider Business Practice Location Address
First Line	:	1640 TIBURON BLVD
Second Line	:	6
City	:	TIBURON
State	:	CA
Zip	:	94920-2515
Country	:	US
Telephone Number	:	415-435-7420
Fax Number	:	415-435-7424

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. GRETCHEN K. ANDREIS
Credential	:	D.C.
Telephone Number	:	415-435-7420

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/25/2007

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Directions to “LORI ANDREIS BERGERON ” Practice Location

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