Organization
PROVANCE CHIROPRACTIC SPORT, FAMILY & REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERRY G PROVANCE DC (CO-OWNER)
(504) 456-9296
Entity
Organization
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
111N00000X
Chiropractor
Primary
414
LA
Other
Enumeration date
08/13/2009
Last updated
05/15/2015
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