Provider Demographics
NPI:1063648152
Name:GONZALES, JOSE LUIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:GONZALES
Suffix:JR
Gender:M
Credentials:DC
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Mailing Address - Street 1:6025 ROYAL LN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3892
Mailing Address - Country:US
Mailing Address - Phone:214-529-1904
Mailing Address - Fax:214-265-8444
Practice Address - Street 1:6025 ROYAL LN
Practice Address - Street 2:SUITE 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3892
Practice Address - Country:US
Practice Address - Phone:214-529-1904
Practice Address - Fax:214-265-8444
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11149111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation