Healthcare Provider Details

I. General information

NPI: 1457038689
Provider Name (Legal Business Name): BRIAN GONZALES CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HAMNER AVE STE 100
NORCO CA
92860-2673
US

IV. Provider business mailing address

2200 HAMNER AVE STE 100
NORCO CA
92860-2673
US

V. Phone/Fax

Practice location:
  • Phone: 951-805-3077
  • Fax: 951-278-4436
Mailing address:
  • Phone: 951-805-3077
  • Fax: 951-278-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN P GONZALES
Title or Position: OWNER
Credential: DS
Phone: 951-805-3077