Provider Demographics
NPI:1588943476
Name:ROSS, JOHN NATHAN (L AC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:NATHAN
Last Name:ROSS
Suffix:
Gender:M
Credentials: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:PO BOX 1880
Mailing Address - Street 2:285 BANK STREET, #A
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-1880
Mailing Address - Country:US
Mailing Address - Phone:508-349-7700
Mailing Address - Fax:
Practice Address - Street 1:285 BANK STREET, # A
Practice Address - Street 2:
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667
Practice Address - Country:US
Practice Address - Phone:508-349-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0709171100000X
CA4401171100000X
MA251463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist