Provider Demographics
NPI:1194863423
Name:GROSS, JAMES L (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:GROSS
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 1:905 QUEEN AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2632
Mailing Address - Country:US
Mailing Address - Phone:541-928-8262
Mailing Address - Fax:541-928-8292
Practice Address - Street 1:905 QUEEN AV SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2632
Practice Address - Country:US
Practice Address - Phone:541-928-8262
Practice Address - Fax:541-928-8292
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGBHFMedicare PIN