Provider Demographics
NPI:1144667569
Name:GONZALEZ CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GONZALEZ CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-962-4500
Mailing Address - Street 1:12480 W 62ND TER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1809
Mailing Address - Country:US
Mailing Address - Phone:913-962-4500
Mailing Address - Fax:913-962-4501
Practice Address - Street 1:12480 W 62ND TER
Practice Address - Street 2:SUITE 103
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1809
Practice Address - Country:US
Practice Address - Phone:913-962-4500
Practice Address - Fax:913-962-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty