Active NPI
Douglas Rendel Bergman, D.C.
- Chiropractor
- Kent, WA
National Provider Identifier
1952350514
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH00002946
- Practice address
- 12901 SE Kent Kangley Rd
Kent, WA 98030-7939 - Phone
- (253) 630-1575
- NPI assigned
- May 9, 2006
- Last updated
- Sep 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | CH00002946 | WA | Primary |
Addresses
Primary practice location
12901 SE Kent Kangley Rd
Kent, WA 98030-7939
Mailing address
6502 36TH St W
University Place, WA 98466-5810
Phone (253) 565-2878
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CH00002946 | WA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Meridian Chiropractic | Chiropractor | Past | Accepting new patients |
| RCC PS | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Kent, WA
- NPI 1376592915
-
- Chiropractor
- Tacoma, WA
- NPI 1932147998
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147132800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1952350514",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6502 36TH ST W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984665810",
"telephone_number": "253-565-2878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12901 SE KENT KANGLEY RD",
"city": "KENT",
"state": "WA",
"postal_code": "980307939",
"telephone_number": "253-630-1575"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGMAN",
"first_name": "DOUGLAS",
"middle_name": "RENDEL",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-09",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WA",
"license": "CH00002946",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.