Provider Demographics
NPI:1740488709
Name:GROSS, KENNETH M (DC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:M
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 1:293 PASSAIC ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5803
Mailing Address - Country:US
Mailing Address - Phone:973-473-3600
Mailing Address - Fax:973-473-3661
Practice Address - Street 1:293 PASSAIC ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5803
Practice Address - Country:US
Practice Address - Phone:973-473-3600
Practice Address - Fax:973-473-3661
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00492900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor