Provider Demographics
NPI:1720009251
Name:ROSS, DEBORAH A (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:ROSS
Suffix:
Gender:F
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:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25725-2408
Mailing Address - Country:US
Mailing Address - Phone:304-525-1901
Mailing Address - Fax:304-525-0277
Practice Address - Street 1:1218 5TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2207
Practice Address - Country:US
Practice Address - Phone:304-525-1901
Practice Address - Fax:304-525-0277
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV355111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV013165900Medicaid
WV248833OtherMAMSI
WA550772013OtherCIGNA
WV550772013OtherWV VETERANS
WV550772013OtherWORKERS COMP
WV550772013OtherAETNA
WV550772013OtherUNITED HEALTH CARE
WV000724450OtherBLUE CROSS/ BLUE SHIELD
WV248833OtherMAMSI