Provider Demographics
NPI:1154451235
Name:BERTRAND, JEFFREY A (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:BERTRAND
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 1:2950 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6114
Mailing Address - Country:US
Mailing Address - Phone:337-626-1800
Mailing Address - Fax:
Practice Address - Street 1:2950 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6114
Practice Address - Country:US
Practice Address - Phone:337-626-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C880Medicare ID - Type UnspecifiedMEDICARE