Provider Demographics
NPI:1548308323
Name:KERIEVSKY, ROSS H (DC, ND)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:H
Last Name:KERIEVSKY
Suffix:
Gender:M
Credentials:DC, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 E BETHANY HOME RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2003
Mailing Address - Country:US
Mailing Address - Phone:602-870-8788
Mailing Address - Fax:602-274-3000
Practice Address - Street 1:1480 E BETHANY HOME RD
Practice Address - Street 2:SUITE 230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2003
Practice Address - Country:US
Practice Address - Phone:602-870-8788
Practice Address - Fax:602-274-3000
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5581111N00000X
AZ00-603175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ81937Medicare UPIN
AZZ62982Medicare PIN