Provider Demographics
NPI:1003807074
Name:GONZALEZ, DANIEL N (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:GONZALEZ
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 1:2004 MELISSA OAKS LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-7958
Mailing Address - Country:US
Mailing Address - Phone:817-504-2157
Mailing Address - Fax:
Practice Address - Street 1:3736 BEE CAVES RD
Practice Address - Street 2:9
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5393
Practice Address - Country:US
Practice Address - Phone:512-347-8881
Practice Address - Fax:512-347-8882
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX04PVOtherBLUECROSS BLUESHIELD
TX04PVOtherBLUECROSS BLUESHIELD