Healthcare Provider Details

I. General information

NPI: 1851021182
Provider Name (Legal Business Name): DR SCOTT GROSS DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 NE DIVISION ST
GRESHAM OR
97030-5812
US

IV. Provider business mailing address

2075 NE DIVISION ST
GRESHAM OR
97030-5812
US

V. Phone/Fax

Practice location:
  • Phone: 503-512-1040
  • Fax: 503-662-7334
Mailing address:
  • Phone: 503-512-1040
  • Fax: 503-662-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SCOTT EDWARD GROSS
Title or Position: OWNER
Credential: DC
Phone: 503-314-9525