Provider Demographics
NPI:1023728318
Name:GONZALEZ RIVERA, JONATHAN OSVALDO (DC)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:OSVALDO
Last Name:GONZALEZ RIVERA
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 1:24 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06103-2501
Mailing Address - Country:US
Mailing Address - Phone:860-278-9141
Mailing Address - Fax:860-525-4013
Practice Address - Street 1:24 LEWIS ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-2501
Practice Address - Country:US
Practice Address - Phone:860-278-9141
Practice Address - Fax:860-525-4013
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty