MEDICARE: DR. CRAIG ROMULO GONZALES 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	5135	OR

General Provider Information

NPI Number	:	1992027718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG ROMULO GONZALES DC

Provider Business Mailing Address
First Line	:	32050 SW WILLAMETTE WAY E
Second Line	:
City	:	WILSONVILLE
State	:	OR
Zip	:	97070-9596
Country	:	US
Telephone Number	:	503-477-2559
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 SW MACADAM AVE STE 285
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3849
Country	:	US
Telephone Number	:	503-894-9111
Fax Number	:	503-217-6424

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

Provider Enumeration Date	:	02/21/2010
Last Update Date	:	07/09/2013

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