Provider Demographics
NPI:1922303098
Name:MERKLE, GORDON (LAC)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:MERKLE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 GARDEN VIEW CT
Mailing Address - Street 2:#101
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2470
Mailing Address - Country:US
Mailing Address - Phone:760-753-2900
Mailing Address - Fax:
Practice Address - Street 1:741 GARDEN VIEW CT
Practice Address - Street 2:#101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2470
Practice Address - Country:US
Practice Address - Phone:760-753-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3420171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist