MEDICARE: DR. JASON M ROSS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301009019	MI

General Provider Information

NPI Number	:	1225058233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON M ROSS D.C.

Provider Business Mailing Address
First Line	:	2448 BLAINE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507
Country	:	US
Telephone Number	:	734-904-3609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1217 N. MONROE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503
Country	:	US
Telephone Number	:	734-904-3609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/04/2010

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