Provider Demographics
NPI:1124633466
Name:ETHRIDGE, NOLAN CRAIG (DC)
Entity type:Individual
Prefix:DR
First Name:NOLAN
Middle Name:CRAIG
Last Name:ETHRIDGE
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 1:11515 BURNHAM DR # 101
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8543
Mailing Address - Country:US
Mailing Address - Phone:253-858-5152
Mailing Address - Fax:253-858-5153
Practice Address - Street 1:11515 BURNHAM DR # 101
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8543
Practice Address - Country:US
Practice Address - Phone:253-858-5152
Practice Address - Fax:253-858-5153
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61085274111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor