Provider Demographics
NPI:1952687709
Name:MERTZ, STEPHEN ALEXANDER (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALEXANDER
Last Name:MERTZ
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 1:5670 EL CAMINO REAL STE F
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7125
Mailing Address - Country:US
Mailing Address - Phone:760-602-0262
Mailing Address - Fax:706-602-0171
Practice Address - Street 1:5670 EL CAMINO REAL STE F
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7125
Practice Address - Country:US
Practice Address - Phone:760-602-0262
Practice Address - Fax:706-602-0171
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18291111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation