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General NPI Number Information
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NPI Number | 1730376542
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Entity Type | Individual
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Provider Name | JERRY WILLIS GOSS DC
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Gender | Male
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 1498 SANS SOUCI PKWY
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City | HANOVER TOWNSHIP
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State | PA
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Zip | 18706-6026
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Country | US
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Telephone | 570-829-5888
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Fax | 570-970-2757
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Provider Business Mailing Address
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Address Line | 1498 SANS SOUCI PKWY
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City | HANOVER TOWNSHIP
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State | PA
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Zip | 18706-6026
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Country | US
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Telephone | 570-829-5888
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Fax | 570-970-2757
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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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | DC-5357 L
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License Number State | PA
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