Provider Demographics
NPI:1285600270
Name:GOOD-BERTRAM, CATHERINE R (DC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:R
Last Name:GOOD-BERTRAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:R
Other - Last Name:GOOD-BERTRAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:321 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4605
Mailing Address - Country:US
Mailing Address - Phone:757-340-5966
Mailing Address - Fax:
Practice Address - Street 1:321 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4605
Practice Address - Country:US
Practice Address - Phone:757-340-5966
Practice Address - Fax:757-747-7708
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA104001394111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA226747OtherANTHEM BCBS
VA350001045Medicare ID - Type UnspecifiedMEDICARE ID#