Individual
GERRY G PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2007 CLEARVIEW PKWY, METAIRIE, LA 70001-2404
(504) 456-9296
(504) 456-9799
Mailing address
2007 CLEARVIEW PKWY, METAIRIE, LA 70001-2404
(504) 456-9296
(504) 456-9799
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
414
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1951340
—
LA
01
—
C8327
BLUE CROSS ID
LA
Enumeration date
02/14/2007
Last updated
07/08/2007
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