Provider Demographics
NPI:1629212287
Name:BERGERHOUSE, JASON WILLIAM
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WILLIAM
Last Name:BERGERHOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BERGERHOUSE
Other - Middle Name:
Other - Last Name:CHIROPRACTIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-0546
Mailing Address - Country:US
Mailing Address - Phone:858-436-7600
Mailing Address - Fax:760-797-1845
Practice Address - Street 1:187 BLUE RAVINE RD STE 140
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4504
Practice Address - Country:US
Practice Address - Phone:165-871-2769
Practice Address - Fax:916-404-0369
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31156111N00000X
CADC31156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty