Provider Demographics
NPI:1891940417
Name:GROSS, STEFANIE ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:STEFANIE
Middle Name:ELIZABETH
Last Name:GROSS
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 1:120 MONUMENT CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-3464
Mailing Address - Country:US
Mailing Address - Phone:815-236-3423
Mailing Address - Fax:
Practice Address - Street 1:120 MONUMENT CT
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-3464
Practice Address - Country:US
Practice Address - Phone:815-236-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor