MEDICARE: BERGLUND CHIROPRACTIC CLINIC SC

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	261QP2300X	Primary Care Clinic/Center	2671	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669682282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGLUND CHIROPRACTIC CLINIC SC

Provider Business Mailing Address
First Line	:	5027 GREEN BAY RD
Second Line	:	STE 118
City	:	KENOSHA
State	:	WI
Zip	:	53144-1771
Country	:	US
Telephone Number	:	262-925-8600
Fax Number	:	262-925-8599

Provider Business Practice Location Address
First Line	:	5027 GREEN BAY RD
Second Line	:	STE 118
City	:	KENOSHA
State	:	WI
Zip	:	53144-1771
Country	:	US
Telephone Number	:	262-925-8600
Fax Number	:	262-925-8599

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL DAVID BERGLUND
Credential	:	DC
Telephone Number	:	262-925-8600

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	03/06/2023

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