Provider Demographics
NPI:1073531208
Name:ROSS, ROBERT LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEWIS
Last Name:ROSS
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 1:1340 FRANK DR
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-4657
Mailing Address - Country:US
Mailing Address - Phone:330-345-7506
Mailing Address - Fax:330-264-2007
Practice Address - Street 1:1340 FRANK DR
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-4657
Practice Address - Country:US
Practice Address - Phone:330-345-7506
Practice Address - Fax:330-264-2007
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0720634Medicaid
OH0720634Medicaid
OH0629072Medicare PIN