Gerry G Provance, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

414 Issued in LA

Practice address

2007 Clearview Pkwy
Metairie, LA 70001-2404

Phone

(504) 456-9296

Fax

(504) 456-9799

NPI assigned

Feb 14, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Provance Chiropractic Sport, Family & Rehab

  • Chiropractor
  • Metairie, LA
  • NPI 1790917490
  NPD Authorized official
• LMB Medical Services LLC

  dba Provance Chiropractic & Wellness

  • Chiropractor
  • Metairie, LA
  • NPI 1518802115
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063555662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 CLEARVIEW PKWY",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700012404",
            "telephone_number": "504-456-9296",
            "fax_number": "504-456-9799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2007 CLEARVIEW PKWY",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700012404",
            "telephone_number": "504-456-9296",
            "fax_number": "504-456-9799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVANCE",
        "first_name": "GERRY",
        "middle_name": "G",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "LA",
            "license": "414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID",
            "identifier": "C8327",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1951340",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Hope Procell, PHD
• Alison M Proctor, P-LPC
• Proniche Medical LLC
• Provance Chiropractic Sport, Family & Rehab
• Provance Chiropractic Sports and Wellness, L.L.C.
• Randy Provensal, CRNA
• Curtis D Prowell Jr., M.D.
• Anthony G. Pruett, MD
• Psyched LLC
• Dawn Marie Puente, MD

• Sports Physician Chiropractor in Metairie, LA
• Providers in Metairie, LA by specialty
• Sports Physician Chiropractor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.