MEDICARE: DR. JOHN PHILLIP 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	X010025	NY
2	111N00000X	Chiropractor	038011331	IL

General Provider Information

NPI Number	:	1659556223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN PHILLIP ROSS D.C.

Provider Business Mailing Address
First Line	:	9 HAMILTON AVE
Second Line	:
City	:	ISLAND PARK
State	:	NY
Zip	:	11558-1605
Country	:	US
Telephone Number	:	516-444-7198
Fax Number	:	171-832-2469

Provider Business Practice Location Address
First Line	:	13102 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-3124
Country	:	US
Telephone Number	:	516-444-7198
Fax Number	:	171-832-2569

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	08/08/2014

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