Provider Demographics
NPI:1760814065
Name:GONZALES, PEDRO (DC)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:777 FAIRWAY DR APT 217
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6783
Mailing Address - Country:US
Mailing Address - Phone:830-556-2187
Mailing Address - Fax:
Practice Address - Street 1:777 FAIRWAY DR APT 217
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-6783
Practice Address - Country:US
Practice Address - Phone:830-556-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor