Provider Demographics
NPI:1386917466
Name:BERGESON, COLE D (DC)
Entity type:Individual
Prefix:DR
First Name:COLE
Middle Name:D
Last Name:BERGESON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BEVINS LN STE D
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-6145
Mailing Address - Country:US
Mailing Address - Phone:502-868-6008
Mailing Address - Fax:502-868-6087
Practice Address - Street 1:204 BEVINS LN STE D
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324
Practice Address - Country:US
Practice Address - Phone:715-933-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5313111N00000X
WI4812-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor