Provider Demographics
NPI:1104858562
Name:GONZALEZ, IOHANN F (DC)
Entity Type:Individual
Prefix:DR
First Name:IOHANN
Middle Name:F
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 1:12800 PRESTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1366
Mailing Address - Country:US
Mailing Address - Phone:469-677-0029
Mailing Address - Fax:214-792-9697
Practice Address - Street 1:12800 PRESTON RD STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1366
Practice Address - Country:US
Practice Address - Phone:469-677-0029
Practice Address - Fax:214-792-9697
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU82293Medicare UPIN
TX611742Medicare ID - Type Unspecified