Provider Demographics
NPI:1871387662
Name:NAHOM, ETHAN GABRIEL (DC)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:GABRIEL
Last Name:NAHOM
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-1633
Mailing Address - Country:US
Mailing Address - Phone:856-881-8811
Mailing Address - Fax:856-881-9152
Practice Address - Street 1:405 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1633
Practice Address - Country:US
Practice Address - Phone:856-881-8811
Practice Address - Fax:856-881-9152
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00812500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor