Provider Demographics
NPI:1871645572
Name:GONZALEZ, MARIO F (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:F
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 1:1834 GLENVIEW RD
Mailing Address - Street 2:STE 2W
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-6921
Mailing Address - Country:US
Mailing Address - Phone:847-730-3988
Mailing Address - Fax:847-730-3989
Practice Address - Street 1:621 MADISON ST STE C
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2203
Practice Address - Country:US
Practice Address - Phone:847-859-2563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38010869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor