Basic Information
| Provider Information | |||||||||
| NPI: | 1003807074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONZALEZ | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2004 MELISSA OAKS LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787447958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175042157 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3736 BEE CAVES RD | ||||||||
| Address2: | 9 | ||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123478881 | ||||||||
| FaxNumber: | 5123478882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 09/04/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 10195 | TX | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 04PV | 01 | TX | BLUECROSS BLUESHIELD | OTHER |