Provider Demographics
NPI:1639473887
Name:GONZALES CORPORATION
Entity Type:Organization
Organization Name:GONZALES CORPORATION
Other - Org Name:APPLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ARHTUR
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:626-330-0651
Mailing Address - Street 1:15658 GALE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1540
Mailing Address - Country:US
Mailing Address - Phone:626-330-0651
Mailing Address - Fax:626-961-0355
Practice Address - Street 1:15658 GALE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1540
Practice Address - Country:US
Practice Address - Phone:626-330-0651
Practice Address - Fax:626-961-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC14379111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1548370026OtherPERSONAL NPI
CADC014379Medicare PIN