Provider Demographics
NPI:1790169258
Name:GONZALEZ, JULIO ANTONIO (DC)
Entity Type:Individual
Prefix:
First Name:JULIO
Middle Name:ANTONIO
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 1:4544 W 14TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3350
Mailing Address - Country:US
Mailing Address - Phone:305-562-2824
Mailing Address - Fax:
Practice Address - Street 1:4544 W 14TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3350
Practice Address - Country:US
Practice Address - Phone:305-562-2824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor