Provider Demographics
NPI:1669590535
Name:BERGMAN, SCOTT L (DC)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:L
Last Name:BERGMAN
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 1:1399 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE #31
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2884
Mailing Address - Country:US
Mailing Address - Phone:925-930-0708
Mailing Address - Fax:
Practice Address - Street 1:1399 YGNACIO VALLEY RD
Practice Address - Street 2:SUITE #31
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2884
Practice Address - Country:US
Practice Address - Phone:925-930-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22592111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition