MEDICARE: MICHAEL DANIEL GONZON 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	DC010994	PA

General Provider Information

NPI Number	:	1922498955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DANIEL GONZON D.C.

Provider Business Mailing Address
First Line	:	PO BOX 1034
Second Line	:
City	:	FOXCROFT SQUARE
State	:	PA
Zip	:	19046-7334
Country	:	US
Telephone Number	:	267-672-1262
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 E HUNTING PARK AVE
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-4928
Country	:	US
Telephone Number	:	267-672-1262
Fax Number	:

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

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	01/29/2015

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