Healthcare Provider Details

I. General information

NPI: 1558395913
Provider Name (Legal Business Name): ANTHONY ADAM GROSS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3006 S RURAL RD
TEMPE AZ
85282-3851
US

IV. Provider business mailing address

3006 S RURAL RD
TEMPE AZ
85282-3851
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-0999
  • Fax: 480-557-4546
Mailing address:
  • Phone: 480-820-0999
  • Fax: 480-557-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number6073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: