MEDICARE: DR. SCOTT LOWELL BERGEN

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	2545	WA

General Provider Information

NPI Number	:	1124126222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT LOWELL BERGEN

Provider Business Mailing Address
First Line	:	314 182ND AVE E
Second Line	:	SUITE D
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-5704
Country	:	US
Telephone Number	:	253-939-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	314 182ND AVE E
Second Line	:	SUITE D
City	:	LAKE TAPPS
State	:	WA
Zip	:	98391-5704
Country	:	US
Telephone Number	:	253-939-2225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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