Provider Demographics
NPI:1790842185
Name:ROSS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:ROSS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-266-3911
Mailing Address - Street 1:411 SALMON AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-2318
Mailing Address - Country:US
Mailing Address - Phone:814-266-3019
Mailing Address - Fax:
Practice Address - Street 1:2831 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1846
Practice Address - Country:US
Practice Address - Phone:814-266-3911
Practice Address - Fax:814-266-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004889L111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013999170004Medicaid
PARO705697Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
PA0013999170004Medicaid