Healthcare Provider Details

I. General information

NPI: 1679631451
Provider Name (Legal Business Name): PETER T GONYEAU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SAGEBRUSH DRIVE SUITE 104
FLOWER MOUND TX
75028
US

IV. Provider business mailing address

2201 LONG PRAIRIE ROAD SUITE 107-845
FLOWER MOUND TX
75022
US

V. Phone/Fax

Practice location:
  • Phone: 972-899-8002
  • Fax: 972-899-8003
Mailing address:
  • Phone: 972-899-8002
  • Fax: 972-899-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number11117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: