Provider Demographics
NPI:1285848325
Name:GOERG, GARY ANTON (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ANTON
Last Name:GOERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61593
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-1593
Mailing Address - Country:US
Mailing Address - Phone:941-536-3356
Mailing Address - Fax:
Practice Address - Street 1:1309 53RD AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2862
Practice Address - Country:US
Practice Address - Phone:941-755-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0007167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0007167OtherLICENSE
FL55458Medicare PIN
FLU63581Medicare UPIN