Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 GENERAL DEGAULLE DR SUITE B
NEW ORLEANS LA
70114-8207
US

IV. Provider business mailing address

3801 GENERAL DEGAULLE DR SUITE B
NEW ORLEANS LA
70114-8207
US

V. Phone/Fax

Practice location:
  • Phone: 504-367-4545
  • Fax: 504-366-3104
Mailing address:
  • Phone: 504-367-4545
  • Fax: 504-366-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1363
License Number StateLA

VIII. Authorized Official

Name: DR. GARY V MERTZ
Title or Position: PRESIDENT
Credential: D.C.
Phone: 337-499-4318