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General NPI Number Information
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NPI Number | 1356489900
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Entity Type | Individual
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Provider Name | JAIME LEONARDO GONZALEZ D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 3100 N. O'CONNOR BLVD. 110
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City | IRVING
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State | TX
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Zip | 75062
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Country | US
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Telephone | 214-794-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 MARKET PLACE BLVD STE 160
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City | IRVING
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State | TX
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Zip | 75063-8099
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Country | US
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Telephone | 214-335-3947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 10511
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License Number State | TX
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