Provider Demographics
NPI:1053659771
Name:ROSS, GENA (DC)
Entity Type:Individual
Prefix:DR
First Name:GENA
Middle Name:
Last Name:ROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 690885
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0885
Mailing Address - Country:US
Mailing Address - Phone:210-617-3023
Mailing Address - Fax:210-519-3010
Practice Address - Street 1:8527 VILLAGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5513
Practice Address - Country:US
Practice Address - Phone:210-617-3023
Practice Address - Fax:201-519-3010
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12090111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation