Provider Demographics
NPI:1316304538
Name:BERTOLINI, VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:BERTOLINI
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 1:5055 N HARBOR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-2302
Mailing Address - Country:US
Mailing Address - Phone:619-523-9355
Mailing Address - Fax:
Practice Address - Street 1:13500 CIRCLE DR STE 102
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1343
Practice Address - Country:US
Practice Address - Phone:708-349-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor