Provider Demographics
NPI:1972652865
Name:GROSS, DESHAN SHERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DESHAN
Middle Name:SHERARD
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:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6100
Mailing Address - Country:US
Mailing Address - Phone:205-868-3741
Mailing Address - Fax:205-868-3744
Practice Address - Street 1:52 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 219
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3430
Practice Address - Country:US
Practice Address - Phone:205-868-3741
Practice Address - Fax:205-868-3744
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALV06987Medicare UPIN
AL051528909GROMedicare ID - Type Unspecified