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General NPI Number Information
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NPI Number | 1902576853
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Entity Type | Organization
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Legal Business Name | CRAIG GONZALES, DC LLC
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 2232 NW PETTYFROVE ST. SUITE 110
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City | PORTLAND
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State | OR
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Zip | 97210
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Country | US
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Telephone | 503-477-2559
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Fax |
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Provider Business Mailing Address
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Address Line | 2232 NW PETTYGROVE ST STE 110
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City | PORTLAND
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State | OR
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Zip | 97210-2372
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Country | US
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Telephone | 503-477-2559
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CRAIG GONZALES
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Credential | DC
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Telephone | 503-477-2559
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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 |
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License Number State |
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