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General NPI Number Information
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NPI Number | 1972595213
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Entity Type | Individual
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Provider Name | GARY ROSS MCLEOD DC
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Gender | Male
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 1107 W BROADWAY ST
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City | THREE RIVERS
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State | MI
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Zip | 49093-9362
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Country | US
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Telephone | 269-273-6712
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Fax | 269-273-3436
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Provider Business Mailing Address
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Address Line | PO BOX 447 1107 W. BROADWAY STREET
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City | THREE RIVERS
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State | MI
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Zip | 49093-0447
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Country | US
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Telephone | 269-273-6712
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Fax | 269-273-3436
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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 | 2301004587
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License Number State | MI
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