Provider Demographics
NPI:1083832786
Name:ROSS, KATHERINE M (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 CLEVELAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0901
Mailing Address - Country:US
Mailing Address - Phone:425-941-6651
Mailing Address - Fax:425-882-3088
Practice Address - Street 1:16701 CLEVELAND ST STE C
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0901
Practice Address - Country:US
Practice Address - Phone:425-941-6651
Practice Address - Fax:425-882-3088
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB24419Medicare ID - Type Unspecified
WAU86998Medicare UPIN