Provider Demographics
NPI:1205309804
Name:GONZALES, NICHOLAS (DC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W US HIGHWAY 64 STE 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-2508
Mailing Address - Country:US
Mailing Address - Phone:336-243-5433
Mailing Address - Fax:
Practice Address - Street 1:215 W US HIGHWAY 64 STE 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-2508
Practice Address - Country:US
Practice Address - Phone:336-243-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor