DR. JACOBY DALE BERGERON DC
NPI 1730763186
Chiropractor in Austin, TX

Q: What is Jacoby Bergeron's NPI number?

The NPI number for Jacoby Bergeron is 1730763186. It was assigned to this individual provider in the NPPES registry on May 11, 2021.

Q: What is Jacoby Bergeron's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Q: When was this NPI record last updated?

The NPPES record for Jacoby Bergeron was last updated on October 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 11, 2021Accepts Medicare Assignment

4030 W BRAKER LN, BLDG 4 SUITE 405, AUSTIN, TX 78759(218) 688-1454 Get Directions Write a Review

NPPES record last updated: October 4, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 4, 2023, May 11, 2021 (2 updates tracked since 2021).

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About Dr. Jacoby Dale Bergeron Dc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACOBY DALE BERGERON DC (NPI 1730763186) is an individual chiropractor in Austin, Texas, licensed in Texas (15566) and active in the NPI registry since May 2021. He is a graduate of Northwestern College Of Chiropractic (2021).

NPPES Registry Identity

NPI1730763186

Entity TypeIndividualMale

Primary Taxonomy111N00000X

Provider Legal NameDR. JACOBY DALE BERGERONCredential: DC

Location Address4030 W BRAKER LN, BLDG 4 SUITE 405Austin, TX 78759-3609

Mailing Address4030 W Braker Ln, Bldg 4 Suite 405Austin, TX 78759-3609 · (218) 688-1454

Phone(218) 688-1454

Sole ProprietorYes

Medical School CMSNorthwestern College Of ChiropracticGraduated 2021

Enumeration DateMay 11, 2021

Last NPPES UpdateOctober 4, 20232 updates tracked since enumeration

NPPES CertifiedOctober 4, 2023

✔ NPI 1730763186 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers

Taxonomy Code111N00000X

License✔ Licensed in TX · 15566

Definition

A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.

4030 W BRAKER LN, Austin, TX 78759

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Jacoby Dale Bergeron Dc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3870992902

PECOS Enrollment IDI20240514002413

Medicare Billing Reassignment

Medicare enrollment records show Jacoby Bergeron reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Bergeron Chiropractic

Same address

Chiropractor

4030 W BRAKER LN, BLDG 4 SUITE 405
Austin, TX 78759

Reassigned Medicare billing, Texas enrollment

NPI 1912787136 (218) 688-1454

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SMART CHOICE DRUGSTORE

Pharmacy (Community/Retail Pharmacy)

4030 W BRAKER LN, STE 400
AUSTIN, TX 78759

Travis County (866) 289-6337

BERGERON CHIROPRACTIC

Chiropractor

4030 W BRAKER LN, BLDG 4 SUITE 405
AUSTIN, TX 78759

Travis County (218) 688-1454

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacoby Bergeron's NPI number?

The NPI number for Jacoby Bergeron is 1730763186. It was assigned to this individual provider in the NPPES registry on May 11, 2021.

Where is Jacoby Bergeron located?

Jacoby Bergeron practices at 4030 W Braker Ln Bldg 4 Suite 405, Austin, TX 78759. The listed phone number is (218) 688-1454.

What is Jacoby Bergeron's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Jacoby Bergeron enrolled in Medicare?

Yes. Jacoby Bergeron is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jacoby Bergeron's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jacoby Bergeron reassigns Medicare benefits to Bergeron Chiropractic (Austin, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacoby Bergeron's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Jacoby Bergeron was last updated on October 4, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.