Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2868 | TX |
N | 111NX0800X | Chiropractor Orthopedic Specialist | TX2868 | TX |
NPI | 1073552733 |
---|---|
Provider Name | Dr. Robert C Bergeron |
First Address | Denison, TX 75020-6709 |
Second Address | Denison, TX 75020-6709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 05/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001149601 | (05) | TX |
137920 | CHIP (01) | TX |
350003440 | RAILROAD MEDICARE (01) | TX |
4365406 | AETNA (01) | TX |
T12188 | (02) | TX |