Provider Demographics
NPI:1942345863
Name:ROSS, BRIAN (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ROSS
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 1:9337 WYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2834
Mailing Address - Country:US
Mailing Address - Phone:818-451-5700
Mailing Address - Fax:747-237-7144
Practice Address - Street 1:9337 WYSTONE AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2834
Practice Address - Country:US
Practice Address - Phone:818-451-5700
Practice Address - Fax:747-237-7144
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7G712Medicare ID - Type Unspecified
V04346Medicare UPIN