MEDICARE: LUZ D. GONZALEZ DC

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	9559	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1578609525	OTHER	TX	GROUP NPI

General Provider Information

NPI Number	:	1538178769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ D. GONZALEZ DC

Provider Business Mailing Address
First Line	:	PO BOX 225275
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-5275
Country	:	US
Telephone Number	:	214-295-6404
Fax Number	:	214-295-5428

Provider Business Practice Location Address
First Line	:	1610 FORT WORTH AVE
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75208-1507
Country	:	US
Telephone Number	:	214-295-6404
Fax Number	:	214-295-5428

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	05/06/2008

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Directions to “ LUZ D. GONZALEZ DC” Practice Location

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