Provider Demographics
NPI:1245278076
Name:ROSS, RICHARD LESLIE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LESLIE
Last Name:ROSS
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 1:2831 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-1846
Mailing Address - Country:US
Mailing Address - Phone:814-266-3911
Mailing Address - Fax:
Practice Address - Street 1:2831 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-1846
Practice Address - Country:US
Practice Address - Phone:814-266-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004889L111N00000X
WV767111N00000X
CO5082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001591848OtherHIGHMARK
PA0013999170004Medicaid
RO705697Medicare ID - Type Unspecified
PA0013999170004Medicaid