Provider Demographics
NPI:1356489900
Name:GONZALEZ, JAIME LEONARDO (DC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LEONARDO
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 1:2240 MARKET PLACE BLVD
Mailing Address - Street 2:STE 160
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-8099
Mailing Address - Country:US
Mailing Address - Phone:214-335-3947
Mailing Address - Fax:
Practice Address - Street 1:3100 N. O'CONNOR BLVD.
Practice Address - Street 2:110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:214-794-6674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor