Individual
DR. JERRY WILLIS GOSS
Active
Individual
DR. JERRY WILLIS GOSS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
DC-5357 L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014723000002
—
PA
01
—
5566734
AETNA
—
01
—
800211
BLUE CROSS
—
01
—
G0127263
FIRST PRIORITY
—
01
—
G01678207
HIGHMARK
—
Enumeration date
09/26/2007
Last updated
09/27/2007
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