Provider Demographics
NPI:1770298374
Name:GEAUXCHIRO OF GONZALES
Entity type:Organization
Organization Name:GEAUXCHIRO OF GONZALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-400-1633
Mailing Address - Street 1:208 E CORNERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3150
Mailing Address - Country:US
Mailing Address - Phone:225-644-8671
Mailing Address - Fax:
Practice Address - Street 1:208 E CORNERVIEW ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-3150
Practice Address - Country:US
Practice Address - Phone:225-644-8671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty