Provider Demographics
NPI:1295934404
Name:BERTKE, TRAVIS HAROLD (DC)
Entity type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:HAROLD
Last Name:BERTKE
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 1:275 N YORK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2766
Mailing Address - Country:US
Mailing Address - Phone:630-617-9790
Mailing Address - Fax:
Practice Address - Street 1:275 N YORK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2766
Practice Address - Country:US
Practice Address - Phone:630-617-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010474111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038010474Medicaid
ILK46803Medicare PIN