Provider Demographics
NPI:1679959340
Name:ROSS, JENNIFER L (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ROSS
Suffix:
Gender:F
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:PO BOX 1417
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-0917
Mailing Address - Country:US
Mailing Address - Phone:330-945-4700
Mailing Address - Fax:330-945-5876
Practice Address - Street 1:911 GRAHAM RD
Practice Address - Street 2:SUITE 66
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1169
Practice Address - Country:US
Practice Address - Phone:330-945-4700
Practice Address - Fax:330-945-5876
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor