Provider Demographics
NPI:1922498955
Name:GONZON, MICHAEL DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DANIEL
Last Name:GONZON
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:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:FOXCROFT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19046-7334
Mailing Address - Country:US
Mailing Address - Phone:267-672-1262
Mailing Address - Fax:
Practice Address - Street 1:1216 E HUNTING PARK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-4928
Practice Address - Country:US
Practice Address - Phone:267-672-1262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor