Provider Demographics
NPI:1801232061
Name:GONZALEZ, ALEJANDRO (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
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 1:12480 W 62ND TER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1809
Mailing Address - Country:US
Mailing Address - Phone:913-962-4500
Mailing Address - Fax:913-962-4501
Practice Address - Street 1:12480 W 62ND TER
Practice Address - Street 2:SUITE 103
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1809
Practice Address - Country:US
Practice Address - Phone:913-962-4500
Practice Address - Fax:913-962-4501
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor