Individual
CARLOS GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.M.T.
Contact information
Practice address
6518 N CLARK ST, CHICAGO, IL 60626-4002
(773) 326-5615
Mailing address
1852 W MORSE AVE, CHICAGO, IL 60626-3109
(773) 326-5615
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.007432
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
227.007432
ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS
IL
Enumeration date
08/05/2014
Last updated
08/05/2014
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