Active NPI
Robert William Bergan, DC
- Chiropractor
- Minneapolis, MN
National Provider Identifier
1063551299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1232
- Practice address
- 2101 Hennepin Ave South
Suite #210
Minneapolis, MN 55405 - Phone
- (612) 871-0700
- Fax
- (612) 874-9827
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 1232 | MN | Primary |
Addresses
Primary practice location
2101 Hennepin Ave South
Suite #210
Minneapolis, MN 55405
Mailing address
2101 Hennepin Ave South
Suite #210
Minneapolis, MN 55405
Phone (612) 871-0700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01250BE | Other | MN | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063551299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 HENNEPIN AVE SOUTH",
"address_2": "SUITE #210",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55405",
"telephone_number": "612-871-0700",
"fax_number": "612-874-9827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2101 HENNEPIN AVE SOUTH",
"address_2": "SUITE #210",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "55405",
"telephone_number": "612-871-0700",
"fax_number": "612-874-9827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGAN",
"first_name": "ROBERT",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "1232",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "01250BE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.