IndividualActive
Jaxon Bergum
NPI 1003574971 · Other Technician · Grand Forks, ND
Provider details
- NPI number
- 1003574971
- Entity type
- Individual
- Primary specialty
- Other TechnicianTechnologists, Technicians & Other Technical Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 10586
Mailing address
930 N 3rd St
Grand Forks, ND 58203-2408
Registry dates
- Enumerated
- 2021-12-07
- Last updated
- 2021-12-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.