Provider Demographics
NPI:1871602821
Name:ROSS, MICHAEL THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:ROSS
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 1:2199 SUNSET BLVD
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-3703
Mailing Address - Country:US
Mailing Address - Phone:740-266-7246
Mailing Address - Fax:740-266-7248
Practice Address - Street 1:2199 SUNSET BLVD
Practice Address - Street 2:SUITE C & D
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-3703
Practice Address - Country:US
Practice Address - Phone:740-266-7246
Practice Address - Fax:740-266-7248
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC 3450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU98136Medicare UPIN
OHRO4124671Medicare PIN