Provider Demographics
NPI:1548532450
Name:BERGMANN, DAVID THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
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 1:662 E BUSINESS HIGHWAY 151
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-3761
Mailing Address - Country:US
Mailing Address - Phone:262-560-4977
Mailing Address - Fax:775-599-9575
Practice Address - Street 1:W359N5920 BROWN ST
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-2488
Practice Address - Country:US
Practice Address - Phone:262-560-4977
Practice Address - Fax:775-599-9575
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4845-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor