Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 10195 | TX |
NPI | 1003807074 |
---|---|
Provider Name | Dr. Daniel N Gonzalez |
First Address | Austin, TX 78744-7958 |
Second Address | West Lake Hills, TX 78746-5393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 04/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04PV | BLUECROSS BLUESHIELD (01) | TX |