Provider Demographics
NPI:1609214840
Name:GOMEZ, JOSEPH DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:GOMEZ
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 1:11400 SPACE CENTER BLVD
Mailing Address - Street 2:APT 7202
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-3598
Mailing Address - Country:US
Mailing Address - Phone:713-550-7585
Mailing Address - Fax:
Practice Address - Street 1:11400 SPACE CENTER BLVD
Practice Address - Street 2:APT 7202
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3598
Practice Address - Country:US
Practice Address - Phone:713-550-7585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor