Provider Demographics
NPI:1487713202
Name:BERGMANN, GENE AUDLEY (DC)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:AUDLEY
Last Name:BERGMANN
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 1:109 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3300
Mailing Address - Country:US
Mailing Address - Phone:626-914-2359
Mailing Address - Fax:626-852-1424
Practice Address - Street 1:109 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3300
Practice Address - Country:US
Practice Address - Phone:626-914-2359
Practice Address - Fax:626-852-1424
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18329111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU36014Medicare UPIN