Nolan Craig Ethridge, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH61085274 Issued in WA

Practice address

11515 Burnham Dr # 101
Gig Harbor, WA 98332-8543

Phone

(253) 858-5152

Fax

(253) 858-5153

NPI assigned

Sep 14, 2020

Last updated

Sep 14, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1124633466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11515 BURNHAM DR # 101",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328543",
            "telephone_number": "253-858-5152",
            "fax_number": "253-858-5153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11515 BURNHAM DR # 101",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328543",
            "telephone_number": "253-858-5152",
            "fax_number": "253-858-5153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHRIDGE",
        "first_name": "NOLAN",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-14",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH61085274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "harborlifechiro@gmail.com",
            "affiliation": "N",
            "address_1": "11515 Burnham Dr # 101",
            "city": "Gig Harbor",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983328543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Chiropractor in Gig Harbor, WA
• Providers in Gig Harbor, WA by specialty
• Chiropractor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.