Provider Demographics
NPI:1538521984
Name:GROSS PERFORMANCE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:GROSS PERFORMANCE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:N
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-225-4082
Mailing Address - Street 1:951 N WALNUT CREEK DR
Mailing Address - Street 2:101
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8025
Mailing Address - Country:US
Mailing Address - Phone:817-225-4082
Mailing Address - Fax:817-225-4083
Practice Address - Street 1:951 N WALNUT CREEK DR
Practice Address - Street 2:101
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8025
Practice Address - Country:US
Practice Address - Phone:817-225-4082
Practice Address - Fax:817-225-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty