MEDICARE: DR. LEVI B 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	2024001828	MO

General Provider Information

NPI Number	:	1548021868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEVI B GONZALEZ DC

Provider Business Mailing Address
First Line	:	412 NW MOCK AVE STE A
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2541
Country	:	US
Telephone Number	:	816-224-3440
Fax Number	:	816-224-3442

Provider Business Practice Location Address
First Line	:	412 NW MOCK AVE STE A
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2541
Country	:	US
Telephone Number	:	816-224-3440
Fax Number	:	816-224-3442

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

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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