Provider Demographics
NPI:1629857461
Name:GONZALEZ, JUAN CARLOS (DC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:GONZALEZ
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 1:641 ANTOINETTE ST
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2620
Mailing Address - Country:US
Mailing Address - Phone:787-587-8652
Mailing Address - Fax:
Practice Address - Street 1:641 ANTOINETTE ST
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2620
Practice Address - Country:US
Practice Address - Phone:787-587-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor