Healthcare Provider Details

I. General information

NPI: 1689656316
Provider Name (Legal Business Name): RICK A. GROSS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 S EOLA RD STE G.
AURORA IL
60503-6494
US

IV. Provider business mailing address

2460 S EOLA RD STE G.
AURORA IL
60503-6494
US

V. Phone/Fax

Practice location:
  • Phone: 630-499-2225
  • Fax: 630-499-2224
Mailing address:
  • Phone: 630-499-2225
  • Fax: 630-499-2224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: