MEDICARE: DFW FAMILY CHIROPRACTIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9559	TX

General Provider Information

NPI Number	:	1578609525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DFW FAMILY CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	PO BOX 225275
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-5275
Country	:	US
Telephone Number	:	214-295-6404
Fax Number	:	214-295-5428

Provider Business Practice Location Address
First Line	:	1610 FORT WORTH AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75208-1507
Country	:	US
Telephone Number	:	214-295-6404
Fax Number	:	214-295-5428

Authorized Official
Title or Position	:	DR.
Name	:	DR. LUZ DIVINA GONZALEZ
Credential	:	DC
Telephone Number	:	214-295-6404

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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