Kenneth Steven Ross, DC JD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH0004634 Issued in FL

Practice address

172 Sausalito Blvd
Casselberry, FL 32707-5764

Phone

(407) 936-7999

Fax

(407) 386-6254

NPI assigned

Oct 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Juris Doctor

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558915200000",
    "number": "1366525073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 SAUSALITO BLVD",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "327075764",
            "telephone_number": "407-936-7999",
            "fax_number": "407-386-6254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "172 SAUSALITO BLVD",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "327075764",
            "telephone_number": "407-936-7999",
            "fax_number": "407-386-6254"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "870 S Sun Dr",
            "address_2": "Suite 1030",
            "address_purpose": "LOCATION",
            "city": "Lake Mary",
            "state": "FL",
            "postal_code": "327462057",
            "country_code": "US",
            "telephone_number": "407-936-7999",
            "fax_number": "407-682-3408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSS",
        "first_name": "KENNETH",
        "middle_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "DC JD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2019-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH0004634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "050508100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC NUMBER",
            "identifier": "CH4634",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Casselberry, FL
• Providers in Casselberry, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.