Provider Demographics
NPI:1386610574
Name:GROSS, BRIAN S (DC, L AC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:S
Last Name:GROSS
Suffix:
Gender:M
Credentials:DC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 ANTHONY RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027
Mailing Address - Country:US
Mailing Address - Phone:215-519-3378
Mailing Address - Fax:
Practice Address - Street 1:1355 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001
Practice Address - Country:US
Practice Address - Phone:215-886-4828
Practice Address - Fax:215-886-2574
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003246L111N00000X
PAAK000902171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30304Medicare UPIN