Provider Demographics
NPI:1043369952
Name:RODRIGUEZ, ROGELIO GABRIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:GABRIEL
Last Name:RODRIGUEZ
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 1:4602 WASHINGTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5434
Mailing Address - Country:US
Mailing Address - Phone:713-457-5600
Mailing Address - Fax:713-457-5501
Practice Address - Street 1:4602 WASHINGTON AVE STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-5434
Practice Address - Country:US
Practice Address - Phone:713-457-5600
Practice Address - Fax:713-457-5501
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8857111NR0400X, 111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NX0100XChiropractic ProvidersChiropractorOccupational Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX753014500OtherEMPLOYER IDENTIFICATION