Provider Demographics
NPI:1972697407
Name:GROSS, CHERYL RENE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:RENE
Last Name:GROSS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2525 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2865
Mailing Address - Country:US
Mailing Address - Phone:503-223-3078
Mailing Address - Fax:503-223-8963
Practice Address - Street 1:2525 NW LOVEJOY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2865
Practice Address - Country:US
Practice Address - Phone:503-223-3078
Practice Address - Fax:503-223-8963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OR2606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGFNHMedicare ID - Type Unspecified