Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 27-2003 | OR |
NPI | 1053433268 |
---|---|
Provider Name | Dr. Gregory Ross |
First Address | Gresham, OR 97030-6333 |
Second Address | Portland, OR 97230-6663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |