Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 12090 | TX |
NPI | 1053659771 |
---|---|
Provider Name | Dr. Gena Ross |
First Address | San Antonio, TX 78269-0885 |
Second Address | San Antonio, TX 78217-5513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2013 |
Last Update Date | 09/07/2014 |