Provider Demographics
NPI:1508153826
Name:GONZALES, JOHN DAVID (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:GONZALES
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 1:9960 BUSINESS PARK DR 140
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1719
Mailing Address - Country:US
Mailing Address - Phone:916-368-7938
Mailing Address - Fax:916-533-9999
Practice Address - Street 1:9960 BUSINESS PARK DR 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1719
Practice Address - Country:US
Practice Address - Phone:916-368-7938
Practice Address - Fax:916-533-9999
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor