Bergstrom, Jaclyn Merry

Bergstrom, Jaclyn Merry is an individual health care provider with primary practice located at 2900 Ne 132Nd Ave , Portland OR 97230-3014. She recently has only one registered license in Chiropractic Providers / Chiropractor, which is considered as her primary health care specialty. Bergstrom, Jaclyn Merry can be contacted via phone (503) 255-6771.

Contact Information

Primary practice address
2900 Ne 132Nd Ave Portland OR 97230-3014
Fax: (503) 251-5794
Website:

Health care specialties

SpecialtyCodeLicense #State
Chiropractic Providers / Chiropractor 111N00000X 705 North Dakota
Chiropractic Providers / Chiropractor 111N00000X 4665 Minnesota
Chiropractic Providers / Chiropractor 111N00000X 5133 Oregon

Profile Details

NPI number 1598715336
LBN Legal business name Bergstrom, Jaclyn Merry
Credentials Doctor of Chiropractic (DC)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Nov 8th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598715336 NPPES
Minnesota MEDICAID 044057400

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