Provider Demographics
NPI:1427104967
Name:GROSS, CURTIS A (DC)
Entity type:Individual
Prefix:MR
First Name:CURTIS
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 1:103 COURT ST
Mailing Address - Street 2:MIDDLEBURY CHIROPRACTIC OFFICE
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-6376
Mailing Address - Fax:802-388-8131
Practice Address - Street 1:103 COURT ST
Practice Address - Street 2:MIDDLEBURY CHIROPRACTIC OFFICE
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-6376
Practice Address - Fax:802-388-8131
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0060000736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00008713Medicaid
VT00008713Medicaid