=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215682265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERCH NATHANIEL FRITZ DC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 04/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 W ANNANDALE RD STE 300
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-600-8208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 W ANNANDALE RD STE 300
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22046-4226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-600-8208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | S04123
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------