Provider Demographics
NPI:1831272921
Name:GONZALEZ, CARLOS MANUEL (DC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:GONZALEZ
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 1:512 PALMARY DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2816
Mailing Address - Country:US
Mailing Address - Phone:915-383-2273
Mailing Address - Fax:888-886-9095
Practice Address - Street 1:512 PALMARY DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2816
Practice Address - Country:US
Practice Address - Phone:915-383-2273
Practice Address - Fax:888-886-9095
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5258111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC5258OtherLICENSE NUMBER