Provider Demographics
NPI:1861484495
Name:GONSER, CARL VERNON (DC)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:VERNON
Last Name:GONSER
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 1:1517 S BETTY LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2209
Mailing Address - Country:US
Mailing Address - Phone:727-461-4858
Mailing Address - Fax:
Practice Address - Street 1:1501 LAKEVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3647
Practice Address - Country:US
Practice Address - Phone:727-447-6779
Practice Address - Fax:727-447-6779
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0001817111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89568Medicare ID - Type Unspecified
FLT56263Medicare UPIN