Provider Demographics
NPI:1982031902
Name:GOMEZ, JOSE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:GOMEZ
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 1:11612 NW 50TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3554
Mailing Address - Country:US
Mailing Address - Phone:315-246-3514
Mailing Address - Fax:
Practice Address - Street 1:1550 N FEDERAL HWY
Practice Address - Street 2:SUITE 15
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-2810
Practice Address - Country:US
Practice Address - Phone:561-742-3554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor