Provider Demographics
NPI:1952322471
Name:GONZALES, FRANK JR (DC)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:GONZALES
Suffix:JR
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 1:801 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4045
Mailing Address - Country:US
Mailing Address - Phone:432-580-3700
Mailing Address - Fax:432-580-3707
Practice Address - Street 1:801 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4045
Practice Address - Country:US
Practice Address - Phone:432-580-3700
Practice Address - Fax:432-580-3707
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9356111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU92100Medicare UPIN
TX8F3571Medicare PIN