Provider Demographics
NPI:1942482450
Name:JAIME L. GONZALEZ, D.C,P.A
Entity Type:Organization
Organization Name:JAIME L. GONZALEZ, D.C,P.A
Other - Org Name:CITY HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LEONARDO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:214-794-6674
Mailing Address - Street 1:3100 NORTH O'CONNOR ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:214-794-6674
Mailing Address - Fax:972-255-5522
Practice Address - Street 1:3100 N. OCONNOR RD
Practice Address - Street 2:110
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:214-794-6674
Practice Address - Fax:972-255-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10511305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service