Provider Demographics
NPI:1265459721
Name:ROSS, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:ROSS
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 1:66483 PIERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-3600
Mailing Address - Country:US
Mailing Address - Phone:760-329-5534
Mailing Address - Fax:760-329-3837
Practice Address - Street 1:66483 PIERSON BLVD
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3600
Practice Address - Country:US
Practice Address - Phone:760-329-5534
Practice Address - Fax:760-329-3837
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350006770OtherRAILROAD MEDICARE PTAN
T04510Medicare UPIN
350006770OtherRAILROAD MEDICARE PTAN