Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 11149 | TX |
NPI | 1063648152 |
---|---|
Provider Name | Dr. Jose Luis Gonzales JR. |
First Address | Dallas, TX 75230-3892 |
Second Address | Dallas, TX 75230-3892 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2009 |
Last Update Date | 03/06/2009 |