Provider Demographics
NPI:1689746760
Name:COOMBER, ROSS (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:COOMBER
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MAIN AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:OCEAN GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07756-1389
Mailing Address - Country:US
Mailing Address - Phone:732-774-1933
Mailing Address - Fax:732-774-2463
Practice Address - Street 1:77 MAIN AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:OCEAN GROVE
Practice Address - State:NJ
Practice Address - Zip Code:07756-1389
Practice Address - Country:US
Practice Address - Phone:732-774-1933
Practice Address - Fax:732-774-2463
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00555000111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ047870Medicare ID - Type Unspecified