Provider Demographics
NPI:1184687709
Name:ROSS, ANTHONY C (CH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:ROSS
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29457-1149
Mailing Address - Country:US
Mailing Address - Phone:843-559-9111
Mailing Address - Fax:843-559-5525
Practice Address - Street 1:3546 MAYBANK HIGHWAY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4822
Practice Address - Country:US
Practice Address - Phone:843-559-9111
Practice Address - Fax:843-559-5525
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1173Medicaid