Provider Demographics
NPI:1053951228
Name:BERTULFO, LOUIS P (DC)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:P
Last Name:BERTULFO
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 1:417 ADVENTUROUS SHIELD DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5409
Mailing Address - Country:US
Mailing Address - Phone:972-971-8614
Mailing Address - Fax:
Practice Address - Street 1:4740 SH 121 STE 200
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-2917
Practice Address - Country:US
Practice Address - Phone:214-618-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor