Provider Demographics
NPI:1558395913
Name:GROSS, ANTHONY ADAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ADAM
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 1:3006 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3851
Mailing Address - Country:US
Mailing Address - Phone:480-820-0999
Mailing Address - Fax:480-557-4546
Practice Address - Street 1:3006 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3851
Practice Address - Country:US
Practice Address - Phone:480-820-0999
Practice Address - Fax:480-557-4546
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6073111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0940570OtherBLUE CROSS/BLUE SHIELD
AZ2435498OtherAETNA
AZZ64540Medicare PIN
AZ2435498OtherAETNA