MEDICARE: NICHOLAS GONZALES D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4975	NC

General Provider Information

NPI Number	:	1205309804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS GONZALES D.C.

Provider Business Mailing Address
First Line	:	215 W US HIGHWAY 64 STE 1
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-2508
Country	:	US
Telephone Number	:	336-243-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	215 W US HIGHWAY 64 STE 1
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27295-2508
Country	:	US
Telephone Number	:	336-243-5433
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	01/07/2019

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Directions to “ NICHOLAS GONZALES D.C.” Practice Location

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