NPIMap

Organization Active NPI

Provance Chiropractic Sport, Family & Rehab

  • Chiropractor
  • Metairie, LA
National Provider Identifier
1790917490
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
414 Issued in LA
Legal business name
PROVANCE CHIROPRACTIC SPORT, FAMILY & REHAB
Practice address
2007 Clearview Pkwy
Metairie, LA 70001-2404
Phone
(504) 456-9296
Fax
(504) 456-9799
NPI assigned
Aug 13, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Authorized official

Name
Dr. Gerry G Provance, DCNPI 1063555662
Title
Co-Owner
Phone
(504) 456-9296

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 414 LA Primary

Addresses

Primary practice location

2007 Clearview Pkwy
Metairie, LA 70001-2404

Mailing address

2007 Clearview Pkwy
Metairie, LA 70001-2404
Phone (504) 456-9296

National Provider Directory

National Provider Directory

Locations

2007 Clearview Pkwy
Metairie, LA 70001
Phone (504) 456-9296

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1250121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1790917490",
    "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": {
        "organization_name": "PROVANCE CHIROPRACTIC SPORT, FAMILY & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-13",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "PROVANCE",
        "authorized_official_first_name": "GERRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "504-456-9296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "LA",
            "license": "414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; 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.