Provider Demographics
NPI:1437346350
Name:CHARLES P GONZALES DC PC
Entity Type:Organization
Organization Name:CHARLES P GONZALES DC PC
Other - Org Name:LIFE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-858-0444
Mailing Address - Street 1:734 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4274
Mailing Address - Country:US
Mailing Address - Phone:201-858-0444
Mailing Address - Fax:201-858-4049
Practice Address - Street 1:734 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4274
Practice Address - Country:US
Practice Address - Phone:201-858-0444
Practice Address - Fax:201-858-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00481200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty