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General NPI Number Information
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NPI Number | 1942482450
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Entity Type | Organization
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Legal Business Name | JAIME L. GONZALEZ, D.C,P.A
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 3100 N. OCONNOR RD 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 | 972-255-5522
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Provider Business Mailing Address
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Address Line | 3100 NORTH O'CONNOR ROAD SUITE 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 | 972-255-5522
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. JAIME LEONARDO GONZALEZ
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Credential | D.C.
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Telephone | 214-794-6674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 10511
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License Number State | TX
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