Provider Demographics
NPI:1497848717
Name:ROSS, MICHAEL G (DC, CSCS, DACRB)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:ROSS
Suffix:
Gender:M
Credentials:DC, CSCS, DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E POPLAR ST # 102
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3009
Mailing Address - Country:US
Mailing Address - Phone:206-271-0908
Mailing Address - Fax:
Practice Address - Street 1:2 E POPLAR ST # 102
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3009
Practice Address - Country:US
Practice Address - Phone:206-271-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH3319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor