Provider Demographics
NPI:1790853372
Name:GOULD, ROSS DAVID (DC, QME)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:DAVID
Last Name:GOULD
Suffix:
Gender:M
Credentials:DC, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20914 NORDHOFF ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5935
Mailing Address - Country:US
Mailing Address - Phone:818-718-9700
Mailing Address - Fax:
Practice Address - Street 1:20914 NORDHOFF ST STE 102
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5935
Practice Address - Country:US
Practice Address - Phone:818-718-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22688111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor