Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | CHIR007644 | GA |
NPI | 1093088759 |
---|---|
Provider Name | Dr. John Michael Ertle |
First Address | Marietta, GA 30067-8005 |
Second Address | Marietta, GA 30067-8005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2012 |
Last Update Date | 10/02/2012 |