NPIMap

Organization Active NPI

Lori Andreis Bergeron

Doing business as Tiburon Wellness Center

  • Chiropractor
  • Tiburon, CA
National Provider Identifier
1104038777
Registry record updated Jul 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC21875 Issued in CA
Legal business name
LORI ANDREIS BERGERON
Doing business as
Tiburon Wellness Center
Practice address
1640 Tiburon Blvd
6
Tiburon, CA 94920-2515
Phone
(415) 435-7420
Fax
(415) 435-7424
NPI assigned
May 4, 2007
Last updated
Jul 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gretchen K. Andreis, D.C.NPI 1780767103
Title
Doctor
Phone
(415) 435-7420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC21875 CA Primary
Chiropractor 111N00000X DC21624 CA

Addresses

Primary practice location

1640 Tiburon Blvd
6
Tiburon, CA 94920-2515

Mailing address

1640 Tiburon Blvd
6
Tiburon, CA 94920-2515
Phone (415) 435-7420

Other names 1

  • Tiburon Wellness Center Doing business as

National Provider Directory

National Provider Directory

Locations

1640 Tiburon Blvd
Ste 6
Tiburon, CA 94920
Phone (415) 435-7420

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185321600000",
    "number": "1104038777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 TIBURON BLVD",
            "address_2": "6",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949202515",
            "telephone_number": "415-435-7420",
            "fax_number": "415-435-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 TIBURON BLVD",
            "address_2": "6",
            "city": "TIBURON",
            "state": "CA",
            "postal_code": "949202515",
            "telephone_number": "415-435-7420",
            "fax_number": "415-435-7424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LORI ANDREIS BERGERON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-07-25",
        "status": "A",
        "authorized_official_last_name": "ANDREIS",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "415-435-7420",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC21875",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC21624",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tiburon Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tiburon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.

Verify at the official NPI Registry.