Provider Demographics
NPI:1376426015
Name:BERGERON, SEBASTIAN MICHAEL (DC)
Entity type:Individual
Prefix:
First Name:SEBASTIAN
Middle Name:MICHAEL
Last Name:BERGERON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4109
Mailing Address - Country:US
Mailing Address - Phone:773-886-0960
Mailing Address - Fax:773-234-9932
Practice Address - Street 1:2908 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4109
Practice Address - Country:US
Practice Address - Phone:773-886-0960
Practice Address - Fax:773-234-9932
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.014323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor