Provider Demographics
NPI:1285784975
Name:ETHERLY, BERNARD (DC)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:
Last Name:ETHERLY
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 1:48 NEW YORK AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1257
Mailing Address - Country:US
Mailing Address - Phone:202-898-0030
Mailing Address - Fax:
Practice Address - Street 1:2420 26TH RD S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2818
Practice Address - Country:US
Practice Address - Phone:703-486-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555772111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician