Healthcare Provider Details

I. General information

NPI: 1033449418
Provider Name (Legal Business Name): GARY V MERTZ & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E PRIEN LAKE RD
LAKE CHARLES LA
70601-7976
US

IV. Provider business mailing address

2301 E PRIEN LAKE RD
LAKE CHARLES LA
70601-7976
US

V. Phone/Fax

Practice location:
  • Phone: 337-478-6172
  • Fax: 337-474-4935
Mailing address:
  • Phone: 337-478-6172
  • Fax: 337-474-4935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1363
License Number StateLA

VIII. Authorized Official

Name: DR. GARY V MERTZ
Title or Position: PRESIDENT
Credential: D.C.
Phone: 337-478-6172