Provider Demographics
NPI:1073887279
Name:BLACK, DOUGLAS ROSS (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ROSS
Last Name:BLACK
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 1:38 COMMERCE PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7257
Mailing Address - Country:US
Mailing Address - Phone:614-586-1060
Mailing Address - Fax:614-586-1061
Practice Address - Street 1:38 COMMERCE PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7257
Practice Address - Country:US
Practice Address - Phone:614-586-1060
Practice Address - Fax:614-586-1061
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor