Provider Demographics
NPI:1659556223
Name:ROSS, JOHN PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
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 1:9 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1605
Mailing Address - Country:US
Mailing Address - Phone:516-444-7198
Mailing Address - Fax:171-832-2469
Practice Address - Street 1:13102 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-3124
Practice Address - Country:US
Practice Address - Phone:516-444-7198
Practice Address - Fax:171-832-2569
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010025111N00000X
IL038011331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6Y601Medicare PIN