Provider Demographics
NPI:1104860014
Name:GROSS, TOM A (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:A
Last Name:GROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CLEMENT DR
Mailing Address - Street 2:
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742
Mailing Address - Country:US
Mailing Address - Phone:828-891-8868
Mailing Address - Fax:828-891-8897
Practice Address - Street 1:4144 HAYWOOD RD
Practice Address - Street 2:STE 4
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742
Practice Address - Country:US
Practice Address - Phone:828-891-8868
Practice Address - Fax:828-891-8897
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2118111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0847BOtherNC STATE HEALTH PLAN
NC0847BOtherBLUE CROSS OF NC
NC890847BMedicaid
NC2449287Medicare ID - Type Unspecified
NC0847BOtherNC STATE HEALTH PLAN