MEDICARE: DR. LEE ANDREW BERGREN DC

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	9406	TX

General Provider Information

NPI Number	:	1689602419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE ANDREW BERGREN DC

Provider Business Mailing Address
First Line	:	PO BOX 1399
Second Line	:
City	:	WHITNEY
State	:	TX
Zip	:	76692
Country	:	US
Telephone Number	:	254-694-2010
Fax Number	:	254-694-2015

Provider Business Practice Location Address
First Line	:	305 S BOSQUE
Second Line	:
City	:	WHITNEY
State	:	TX
Zip	:	76692
Country	:	US
Telephone Number	:	254-694-2010
Fax Number	:	254-694-2015

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/05/2007

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