Jaxon Bergum

NPI #1003574971 in Grand Forks, North Dakota

Provider Information

NPI Number: 1003574971
Entity Type: Individual
Name: Jaxon Bergum
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician, Other
Enumeration Date: Dec 7, 2021
Last Updated: Dec 7, 2021

Practice Location

Address: 930 N 3RD ST
City: Grand Forks
State: North Dakota
ZIP Code: 58203-2408
Phone: (701) 795-9143

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician, Other	247200000X	Primary

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