Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CH9083 | FL |
NPI | 1083833370 |
---|---|
Provider Name | Dr. Matthew Robert Bergtold |
First Address | Naples, FL 34102-5756 |
Second Address | Naples, FL 34102-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 21/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DE733Y | (02) | FL |