Provider Demographics
NPI:1821174574
Name:ERTLE, MEIRAV (DC)
Entity Type:Individual
Prefix:MRS
First Name:MEIRAV
Middle Name:
Last Name:ERTLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 FRANKLIN RD SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8060
Mailing Address - Country:US
Mailing Address - Phone:770-951-0080
Mailing Address - Fax:770-980-1500
Practice Address - Street 1:1033 FRANKLIN RD SE
Practice Address - Street 2:SUITE C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8060
Practice Address - Country:US
Practice Address - Phone:770-951-0080
Practice Address - Fax:770-980-1500
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007016111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCGXMMedicare ID - Type UnspecifiedCHIROPRACTOR