Provider Demographics
NPI:1952446577
Name:ROSS CHIROPRACTIC, PLC
Entity Type:Organization
Organization Name:ROSS CHIROPRACTIC, PLC
Other - Org Name:ROSS PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-467-3830
Mailing Address - Street 1:35927 FORD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2204
Mailing Address - Country:US
Mailing Address - Phone:734-467-3830
Mailing Address - Fax:734-467-3836
Practice Address - Street 1:35927 FORD RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2204
Practice Address - Country:US
Practice Address - Phone:734-467-3830
Practice Address - Fax:734-467-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950B550980OtherBCBS
MIP00209157OtherRAILROAD MEDICARE
MI950B550980OtherBCBS