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General NPI Number Information
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NPI Number | 1295181774
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Entity Type | Organization
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Legal Business Name | GONZALEZ FAMILY CHIROPRACTIC LLC.
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 1105 4TH AVENUE
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City | WOODRUFF
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State | WI
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Zip | 54568-2061
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Country | US
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Telephone | 715-356-1606
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Fax | 715-356-2170
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Provider Business Mailing Address
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Address Line | 1105 4TH AVENUE PO BOX 2061
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City | WOODRUFF
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State | WI
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Zip | 54568-2061
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Country | US
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Telephone | 715-356-1606
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Fax | 715-356-2170
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Authorized Official
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Title or Position | MEMBER/OWNER
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Name | DR. GUILLERMO EDUARDO GONZALEZ
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Credential | D.C.
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Telephone | 715-356-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 3390-12
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3390-12
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License Number State | WI
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