Provider Demographics
NPI:1992027718
Name:GONZALES, CRAIG ROMULO (DC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ROMULO
Last Name:GONZALES
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 1:32050 SW WILLAMETTE WAY E
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9596
Mailing Address - Country:US
Mailing Address - Phone:503-477-2559
Mailing Address - Fax:
Practice Address - Street 1:5331 SW MACADAM AVE STE 285
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3849
Practice Address - Country:US
Practice Address - Phone:503-894-9111
Practice Address - Fax:503-217-6424
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-21
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor