Provider Demographics
NPI:1053527317
Name:ROSS, STEPHEN JAMES (DC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JAMES
Last Name:ROSS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 SW 153RD DRIVE
Mailing Address - Street 2:STE 210
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006
Mailing Address - Country:US
Mailing Address - Phone:503-644-0600
Mailing Address - Fax:503-644-0609
Practice Address - Street 1:3925 SW 153RD DRIVE
Practice Address - Street 2:STE 210
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006
Practice Address - Country:US
Practice Address - Phone:503-644-0600
Practice Address - Fax:503-644-0609
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR116267Medicare ID - Type Unspecified