Provider Demographics
NPI:1972265122
Name:GROSS, BROCK ANDRU (DC)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:ANDRU
Last Name:GROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-2484
Mailing Address - Country:US
Mailing Address - Phone:219-218-1629
Mailing Address - Fax:
Practice Address - Street 1:1425 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1386
Practice Address - Country:US
Practice Address - Phone:219-627-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003250A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor