MEDICARE: CATHERINE R GOOD-BERTRAM D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	104001394	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	226747	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1285600270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE R GOOD-BERTRAM D.C.

Provider Business Mailing Address
First Line	:	321 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4605
Country	:	US
Telephone Number	:	757-340-5966
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 FIRST COLONIAL RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-4605
Country	:	US
Telephone Number	:	757-340-5966
Fax Number	:	757-747-7708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	01/10/2011

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