Provider Demographics
NPI:1013071216
Name:BERTRAND, SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
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 1:3433 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-1911
Mailing Address - Country:US
Mailing Address - Phone:404-766-0676
Mailing Address - Fax:404-766-1131
Practice Address - Street 1:3433 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-1911
Practice Address - Country:US
Practice Address - Phone:404-766-0676
Practice Address - Fax:404-766-1131
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU18685-BCIMedicare UPIN
GA35ZCBSPMedicare ID - Type Unspecified