Provider Demographics
NPI:1568561660
Name:GONSALVES, CHRISTIAN HUNTER (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:HUNTER
Last Name:GONSALVES
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 1:303 TAMIAMI TRL S
Mailing Address - Street 2:UNIT F
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-3104
Mailing Address - Country:US
Mailing Address - Phone:941-488-2008
Mailing Address - Fax:
Practice Address - Street 1:303 TAMIAMI TRL S
Practice Address - Street 2:UNIT F
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3104
Practice Address - Country:US
Practice Address - Phone:941-488-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8099111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU79303Medicare UPIN
FL70065XMedicare PIN