Provider Demographics
NPI:1902105455
Name:ROSS, KAITLIN M (DC)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:M
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 1:2475 E NINE MILD RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514
Mailing Address - Country:US
Mailing Address - Phone:850-791-6222
Mailing Address - Fax:850-607-6822
Practice Address - Street 1:2475 E NINE MILE RD
Practice Address - Street 2:SUITE F
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-791-6222
Practice Address - Fax:850-607-6822
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL220EJOtherBLUECROSS BLUESHIELD OF FLORIDA
AL592-21490OtherBLUECROSS BLUESHIELD OF ALABAMA
AL592-21490OtherBLUECROSS BLUESHIELD OF ALABAMA