Provider Demographics
NPI:1316161094
Name:ROSS, JEFFREY ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALLAN
Last Name:ROSS
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 1:148 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2713
Mailing Address - Country:US
Mailing Address - Phone:716-686-0868
Mailing Address - Fax:716-686-0869
Practice Address - Street 1:5660 CLINTON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:ELMA
Practice Address - State:NY
Practice Address - Zip Code:14059-9494
Practice Address - Country:US
Practice Address - Phone:716-686-0868
Practice Address - Fax:716-686-0869
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007933111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU64973Medicare UPIN
NY14191BMedicare ID - Type Unspecified