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General NPI Number Information
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NPI Number | 1538206081
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Entity Type | Individual
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Provider Name | STAN M GROSS DC
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 331 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-5351
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Country | US
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Telephone | 636-928-5588
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Fax | 636-922-0071
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Provider Business Mailing Address
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Address Line | 331 JUNGERMANN RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-5351
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Country | US
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Telephone | 636-928-5588
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Fax | 636-922-0071
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CE00005721
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License Number State | MO
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