Provider Demographics
NPI:1073673588
Name:DR. BILL ROSS, DC, LLC
Entity Type:Organization
Organization Name:DR. BILL ROSS, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-748-1099
Mailing Address - Street 1:319 E JIMMIE LEEDS RD STE C4
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4125
Mailing Address - Country:US
Mailing Address - Phone:097-481-0996
Mailing Address - Fax:609-748-1216
Practice Address - Street 1:160 S NEW YORK RD
Practice Address - Street 2:C4
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-3820
Practice Address - Country:US
Practice Address - Phone:609-748-1099
Practice Address - Fax:609-748-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00569700111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9130802Medicaid
NJ=========OtherTAX ID