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General NPI Number Information
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NPI Number | 1144667569
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Entity Type | Organization
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Legal Business Name | GONZALEZ CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 05/24/2013
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Provider Practice Location Address
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Address Line | 12480 W 62ND TER SUITE 103
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City | SHAWNEE
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State | KS
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Zip | 66216-1809
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Country | US
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Telephone | 913-962-4500
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Fax | 913-962-4501
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Provider Business Mailing Address
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Address Line | 12480 W 62ND TER SUITE 103
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City | SHAWNEE
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State | KS
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Zip | 66216-1809
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Country | US
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Telephone | 913-962-4500
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Fax | 913-962-4501
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. ALEJANDRO GONZALEZ
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Credential | DC
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Telephone | 913-962-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01-05544
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License Number State | KS
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