Provance, Gerry G
Provance, Gerry G is an individual health care provider with primary practice located at 2007 Clearview Pkwy , Metairie LA 70001-2404. He recently has only one registered license in Chiropractic Providers / Sports Physician, which is considered as his primary health care specialty. Provance, Gerry G can be contacted via phone (504) 456-9296.Contact Information
Primary practice address
2007 Clearview Pkwy
Metairie LA 70001-2404
Phone: (504) 456-9296
Fax: (504) 456-9799
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Chiropractic Providers / Sports Physician | 111NS0005X | 414 | Louisiana |
Profile Details
| NPI number | 1063555662 |
|---|---|
| LBN Legal business name | Provance, Gerry G |
| Credentials | Doctor of Chiropractic (DC) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 14th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063555662 | NPPES |
| Louisiana | Other | C8327 | BLUE CROSS ID |
| Louisiana | MEDICAID | 1951340 | BLUE CROSS ID |
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