Provider Demographics
NPI:1447230024
Name:BERTELSMAN, TIMOTHY JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:BERTELSMAN
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 1:4460 NORTH ILLINIOIS STREET
Mailing Address - Street 2:5
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1899
Mailing Address - Country:US
Mailing Address - Phone:618-236-3738
Mailing Address - Fax:618-257-3291
Practice Address - Street 1:4460 N ILLINOIS ST
Practice Address - Street 2:5
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1899
Practice Address - Country:US
Practice Address - Phone:618-236-3738
Practice Address - Fax:618-257-3291
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK19364Medicare PIN
ILU26360Medicare UPIN