Nicholas Alvin Bergen

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00024715 Issued in WA

Practice address

15412 E Sprague Ave Ste 17
Spokane Valley, WA 99037-8841

Phone

(509) 443-3117

NPI assigned

Jan 18, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1200614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1228694400000",
    "number": "1871779991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2608 N MARTIN ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992074953",
            "telephone_number": "509-216-3781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15412 E SPRAGUE AVE STE 17",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "990378841",
            "telephone_number": "509-443-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGEN",
        "first_name": "NICHOLAS",
        "middle_name": "ALVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-18",
        "last_updated": "2008-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00024715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MA00024715",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Berberich, MSW
• Zack Berezay
• Michael James Berg
• Tracy A Berg, M.D.
• Bailey Bergdahl
• Morgan Berggren-Mustard
• Jessica Beth Berghoff, RD CD
• Bryan James Bergstrom, LMFT
• Tristina Krakenberg Bermingham
• JB McGregor Bermudez-Koch, DMD DE61197009

• Massage Therapist in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; 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.