Provider Demographics
NPI:1477315612
Name:GONZALEZ, JENNIFER GUADALUPE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GUADALUPE
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 KELLER SPRINGS RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-4849
Mailing Address - Country:US
Mailing Address - Phone:972-418-5150
Mailing Address - Fax:
Practice Address - Street 1:2840 KELLER SPRINGS RD STE 301
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-4849
Practice Address - Country:US
Practice Address - Phone:972-418-5150
Practice Address - Fax:972-416-6827
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty