Provider Demographics
NPI:1831346790
Name:GROSS, DONALD LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LOUIS
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 1:9505 19TH AVE. SE #109
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3841
Mailing Address - Country:US
Mailing Address - Phone:425-337-1243
Mailing Address - Fax:
Practice Address - Street 1:9505 19TH AVE. SE #109
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3841
Practice Address - Country:US
Practice Address - Phone:425-337-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001604111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA155490OtherL AND I
WA155490OtherL AND I
AB37856Medicare PIN