Provider Demographics
NPI:1407992423
Name:BERKOWITZ, JAY BRADLEY (DC)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:BRADLEY
Last Name:BERKOWITZ
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 1:4867 BAXTER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4469
Mailing Address - Country:US
Mailing Address - Phone:757-497-8737
Mailing Address - Fax:757-497-2715
Practice Address - Street 1:4867 BAXTER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4469
Practice Address - Country:US
Practice Address - Phone:757-497-1555
Practice Address - Fax:757-497-2715
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC03082OtherMEDICARE
GAU99854Medicare UPIN