Healthcare Provider Details

I. General information

NPI: 1033455456
Provider Name (Legal Business Name): MEGAN MELISSA ROSS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HILLCREST DR LOWER LEVEL
ALFRED NY
14802-1007
US

IV. Provider business mailing address

4 FAIRLAWN AVE
HORNELL NY
14843-1722
US

V. Phone/Fax

Practice location:
  • Phone: 607-247-4017
  • Fax:
Mailing address:
  • Phone: 585-738-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX012269-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: