Basic Information
| Provider Information | |||||||||
| NPI: | 1639163066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROSS | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 SWALLOW HILL RD | ||||||||
| Address2: | BUILDING 2600 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152201656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122794522 | ||||||||
| FaxNumber: | 4122793416 | ||||||||
| Practice Location | |||||||||
| Address1: | 2275 SWALLOW HILL RD | ||||||||
| Address2: | BUILDING 2600 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152201656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122794522 | ||||||||
| FaxNumber: | 4122793416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | DC007869L | PA | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 919540 | 01 | PA | BLUE SHIELD # | OTHER |