MEDICARE: GARY V MERTZ, D.C. AND ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0400X	Rehabilitation Chiropractor	1363	LA

General Provider Information

NPI Number	:	1356656011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY V MERTZ, D.C. AND ASSOCIATES

Provider Business Mailing Address
First Line	:	3801 GENERAL DEGAULLE DR
Second Line	:	SUITE B
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8207
Country	:	US
Telephone Number	:	504-367-4545
Fax Number	:	504-366-3104

Provider Business Practice Location Address
First Line	:	3801 GENERAL DEGAULLE DR
Second Line	:	SUITE B
City	:	NEW ORLEANS
State	:	LA
Zip	:	70114-8207
Country	:	US
Telephone Number	:	504-367-4545
Fax Number	:	504-366-3104

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY V MERTZ
Credential	:	D.C.
Telephone Number	:	337-499-4318

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	08/18/2010

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