NPI 1063555662

Gerry G Provance, DC

Practitioner Sports Physician Chiropractor Metairie, LA

Practice location

Address: 2007 Clearview Pkwy, Metairie, LA 70001-2404
Phone: (504) 456-9296
Fax: (504) 456-9799

Registered specialties

Sports Physician Chiropractor Primary

Chiropractic Providers Taxonomy 111NS0005X Licence 414 (LA)

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Registry record

NPI: 1063555662
Entity type: Individual
Sex (as registered): Male
NPI issued: 14 Feb 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.