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NPI Code Detail

MEDICARE: DR. JAY PATRICK BERTSCH D.C.

MEDICARE: DR. JAY PATRICK BERTSCH 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
1111N00000XChiropractor2766MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164426607
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY PATRICK BERTSCH D.C.
Provider Business Mailing Address
First Line : 12217 CHAMPLIN DR
Second Line :
City : CHAMPLIN
State : MN
Zip : 55316-1930
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12217 CHAMPLIN DR
Second Line :
City : CHAMPLIN
State : MN
Zip : 55316-1930
Country : US
Telephone Number : 763-323-1492
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/08/2007

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