Provider Demographics
NPI:1740262708
Name:HART, ROSS MILES (DC)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:MILES
Last Name:HART
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 1:1132 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-3018
Mailing Address - Country:US
Mailing Address - Phone:541-726-6521
Mailing Address - Fax:541-726-1615
Practice Address - Street 1:1132 N 5TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3018
Practice Address - Country:US
Practice Address - Phone:541-726-6521
Practice Address - Fax:541-726-1615
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T67698Medicare UPIN
R0000QEBJZMedicare ID - Type Unspecified