Lori Bergeron, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

17636 Issued in CA

Practice address

1640 Tiburon Blvd
6
Tiburon, CA 94920-2515

Phone

(415) 435-7420

Fax

(415) 435-7424

NPI assigned

Feb 18, 2010

Sex

Female

Sole proprietor

Yes

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lori Andreis Bergeron

  • Chiropractor
  • Tiburon, CA
  • NPI 1104038777
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 18, 2010.

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266451200000",
    "number": "1659693554",
    "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": {
        "last_name": "BERGERON",
        "first_name": "LORI",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "17636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Tiburon, CA
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; 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.