Provider Demographics
NPI:1992370845
Name:TREBACH, NATHANIEL D (DC)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:D
Last Name:TREBACH
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 1:8609 WESTWOOD CENTER DR STE 620
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-7534
Mailing Address - Country:US
Mailing Address - Phone:703-904-9666
Mailing Address - Fax:
Practice Address - Street 1:8609 WESTWOOD CENTER DR STE 620
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7534
Practice Address - Country:US
Practice Address - Phone:703-904-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor