Provider Demographics
NPI:1407866882
Name:GROSS, MICHAEL ALAN (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
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 1:1563 FALL RIVER AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-3736
Mailing Address - Country:US
Mailing Address - Phone:508-336-2663
Mailing Address - Fax:508-336-2225
Practice Address - Street 1:1563 FALL RIVER AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-3736
Practice Address - Country:US
Practice Address - Phone:508-336-2663
Practice Address - Fax:508-336-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2016-03-30
Deactivation Date:2007-02-22
Deactivation Code:
Reactivation Date:2007-11-26
Provider Licenses
StateLicense IDTaxonomies
MA1981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA401583OtherCIGNA
MAY36469OtherBLUE CROSS OF MA
MA457549OtherTUFTS
MA1015441OtherAETNA
MA4400650OtherUNITED HEALTH CARE
MA350158OtherHARVARD PILGRIM
MAY36469OtherBLUE CROSS OF MA