Provider Demographics
NPI:1457367328
Name:GROSS, ERIC M (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:GROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5663 BALBOA AVE
Mailing Address - Street 2:#361
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-349-8606
Mailing Address - Fax:858-362-1231
Practice Address - Street 1:3670 CLAIREMONT DR
Practice Address - Street 2:#7
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117
Practice Address - Country:US
Practice Address - Phone:858-581-0664
Practice Address - Fax:858-362-1231
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC26058Medicare ID - Type Unspecified
U79310Medicare UPIN