MEDICARE: GARY A. GOERG, DC, PA

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	111N00000X	Chiropractor	CH7167	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K8198	OTHER	FL	GROUP IDENTIFICATION NUMBER PER CCN:920515184914
2	U63581	OTHER	FL	UPIN PER CCN: 920515184914
3	55458Z	OTHER	FL	PROVIDER NUMBER PER CCN: 920515184914

General Provider Information

NPI Number	:	1346481520
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY A. GOERG, DC, PA

Provider Business Mailing Address
First Line	:	2496 CARING WAY
Second Line	:	UNIT B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5336
Country	:	US
Telephone Number	:	941-235-3535
Fax Number	:	941-235-3550

Provider Business Practice Location Address
First Line	:	2496 CARING WAY
Second Line	:	UNIT B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5336
Country	:	US
Telephone Number	:	941-235-3535
Fax Number	:	941-235-3550

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GARY ANTON GOERG
Credential	:	D.C.
Telephone Number	:	941-235-3535

Provider Enumeration Date	:	03/17/2009
Last Update Date	:	03/17/2009

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