Provider Demographics
NPI:1336573724
Name:GENTRY, ETHAN EDWARD ARNO (DC)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:EDWARD ARNO
Last Name:GENTRY
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 1:2010 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-5007
Mailing Address - Country:US
Mailing Address - Phone:661-638-0922
Mailing Address - Fax:
Practice Address - Street 1:2010 16TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5007
Practice Address - Country:US
Practice Address - Phone:661-638-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32706111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor