Provider Demographics
NPI:1083687495
Name:RODRIGUEZ, JOHN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
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 1:6378 EWE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-8643
Mailing Address - Country:US
Mailing Address - Phone:330-882-5822
Mailing Address - Fax:
Practice Address - Street 1:843 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9668
Practice Address - Country:US
Practice Address - Phone:330-877-3177
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3616111N00000X
CA26309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRO4164832Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
OHU53254Medicare UPIN