Provider Demographics
NPI:1851021182
Name:DR SCOTT GROSS DC LLC
Entity Type:Organization
Organization Name:DR SCOTT GROSS DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-314-9525
Mailing Address - Street 1:2075 NE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5812
Mailing Address - Country:US
Mailing Address - Phone:503-512-1040
Mailing Address - Fax:503-662-7334
Practice Address - Street 1:2075 NE DIVISION ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5812
Practice Address - Country:US
Practice Address - Phone:503-512-1040
Practice Address - Fax:503-662-7334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1487151650Medicaid