Provider Demographics
NPI:1205362894
Name:GONZALEZ, PETER JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
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 1:21150 W CAPITOL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2911
Mailing Address - Country:US
Mailing Address - Phone:414-482-5282
Mailing Address - Fax:
Practice Address - Street 1:21150 W CAPITOL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53072-2911
Practice Address - Country:US
Practice Address - Phone:414-482-5282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5273-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor