Provider Demographics
NPI:1053821025
Name:GOMEZ FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:GOMEZ FAMILY CHIROPRACTIC PLLC
Other - Org Name:ONE LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:210-618-5180
Mailing Address - Street 1:2211 FRY RD STE O
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6233
Mailing Address - Country:US
Mailing Address - Phone:832-321-3452
Mailing Address - Fax:
Practice Address - Street 1:2211 FRY RD STE O
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6233
Practice Address - Country:US
Practice Address - Phone:832-321-3452
Practice Address - Fax:833-746-4523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12889111N00000X
261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty