Provider Demographics
NPI:1497818769
Name:BERTRAND, WILLARD G (DC)
Entity Type:Individual
Prefix:
First Name:WILLARD
Middle Name:G
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 1:1493 N COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:OR
Mailing Address - Zip Code:97883-9227
Mailing Address - Country:US
Mailing Address - Phone:541-805-9123
Mailing Address - Fax:541-204-8826
Practice Address - Street 1:1493 N COLLEGE ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:OR
Practice Address - Zip Code:97883-9227
Practice Address - Country:US
Practice Address - Phone:541-805-9123
Practice Address - Fax:541-204-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-1655111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR247353Medicare ID - Type Unspecified