Provider Demographics
NPI:1396871232
Name:MERTZ, GARY V (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:V
Last Name:MERTZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:2301 E PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7976
Mailing Address - Country:US
Mailing Address - Phone:337-478-6172
Mailing Address - Fax:337-474-4935
Practice Address - Street 1:2301 E PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7976
Practice Address - Country:US
Practice Address - Phone:337-478-6172
Practice Address - Fax:337-474-4935
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1363111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation