MEDICARE: JAY BRADLEY BERKOWITZ 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	0104556586	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C03082	OTHER	VA	MEDICARE

General Provider Information

NPI Number	:	1407992423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY BRADLEY BERKOWITZ D.C

Provider Business Mailing Address
First Line	:	4867 BAXTER RD STE 107
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-497-8737
Fax Number	:	757-497-2715

Provider Business Practice Location Address
First Line	:	4867 BAXTER RD
Second Line	:	SUITE 107
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4469
Country	:	US
Telephone Number	:	757-497-1555
Fax Number	:	757-497-2715

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	02/14/2022

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