Healthcare Provider Details

I. General information

NPI: 1285784975
Provider Name (Legal Business Name): BERNARD ETHERLY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 26TH RD S
ARLINGTON VA
22206-2818
US

IV. Provider business mailing address

48 NEW YORK AVE NW
WASHINGTON DC
20001-1257
US

V. Phone/Fax

Practice location:
  • Phone: 703-486-2225
  • Fax:
Mailing address:
  • Phone: 202-898-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104555772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: