Provider Demographics
NPI:1124203724
Name:JESUS E. GONZALEZ CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:JESUS E. GONZALEZ CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:D,C
Authorized Official - Phone:281-464-0118
Mailing Address - Street 1:10988 FUQUA ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2410
Mailing Address - Country:US
Mailing Address - Phone:281-464-0118
Mailing Address - Fax:281-464-0119
Practice Address - Street 1:10988 FUQUA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2410
Practice Address - Country:US
Practice Address - Phone:281-464-0118
Practice Address - Fax:281-464-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty