Provider Demographics
NPI:1346481520
Name:GARY A. GOERG, DC, PA
Entity Type:Organization
Organization Name:GARY A. GOERG, DC, PA
Other - Org Name:BACK PAIN INSTITUTE OF PORT CHARLOTTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:GOERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-235-3535
Mailing Address - Street 1:2496 CARING WAY
Mailing Address - Street 2:UNIT B
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5336
Mailing Address - Country:US
Mailing Address - Phone:941-235-3535
Mailing Address - Fax:941-235-3550
Practice Address - Street 1:2496 CARING WAY
Practice Address - Street 2:UNIT B
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5336
Practice Address - Country:US
Practice Address - Phone:941-235-3535
Practice Address - Fax:941-235-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8198OtherGROUP IDENTIFICATION NUMBER PER CCN:920515184914
FLU63581OtherUPIN PER CCN: 920515184914
FL55458ZOtherPROVIDER NUMBER PER CCN: 920515184914