Provider Demographics
NPI:1831150283
Name:GROSS, TIMOTHY CLAY (DC)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CLAY
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:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023
Mailing Address - Country:US
Mailing Address - Phone:501-941-3008
Mailing Address - Fax:501-941-3007
Practice Address - Street 1:309 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-2911
Practice Address - Country:US
Practice Address - Phone:501-941-3008
Practice Address - Fax:501-941-3007
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR06060023300OtherQUAL CHOICE
AR5032683OtherCIGNA
AR7172792OtherAETNA
AR7172792OtherAETNA
AR5Y850Medicare ID - Type Unspecified