Provider Demographics
NPI:1043537749
Name:GROSS, DUSTIN DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:DUANE
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 1:110 S. MESA DR. SUITE 4
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:480-833-8863
Mailing Address - Fax:480-464-5516
Practice Address - Street 1:110 S MESA DR STE 4
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1458
Practice Address - Country:US
Practice Address - Phone:480-833-8863
Practice Address - Fax:480-464-5516
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor