Provider Demographics
NPI:1033449418
Name:GARY V MERTZ & ASSOCIATES
Entity Type:Organization
Organization Name:GARY V MERTZ & ASSOCIATES
Other - Org Name:LA. CHIROPRACTIC AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:V
Authorized Official - Last Name:MERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:337-478-6172
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty