Provider Demographics
NPI:1023756772
Name:BALANCED LIVERMORE A BERGLUND CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:BALANCED LIVERMORE A BERGLUND CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BERGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:408-309-3769
Mailing Address - Street 1:476 COLEEN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4017
Mailing Address - Country:US
Mailing Address - Phone:408-309-3769
Mailing Address - Fax:
Practice Address - Street 1:1422 CONCANNON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6006
Practice Address - Country:US
Practice Address - Phone:408-309-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty