Provider Demographics
NPI:1699988782
Name:GROSS, JASON N (DC)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:N
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 1:5225 MORNING SUN RD STE C
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8929
Mailing Address - Country:US
Mailing Address - Phone:716-352-0802
Mailing Address - Fax:
Practice Address - Street 1:5337 MILLER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-6422
Practice Address - Country:US
Practice Address - Phone:716-352-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05195111N00000X
TX12171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC11371-4WOtherWORKERS COMPENSATION