Provider Demographics
NPI:1164700811
Name:GONZALEZ, AMY N (DC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:N
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:VAVRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2300 MATLOCK RD.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063
Mailing Address - Country:US
Mailing Address - Phone:817-528-8619
Mailing Address - Fax:817-527-2719
Practice Address - Street 1:2300 MATLOCK RD STE 3
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5018
Practice Address - Country:US
Practice Address - Phone:817-528-8619
Practice Address - Fax:817-755-1788
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor