Provider Demographics
NPI:1083715130
Name:RODRIGUEZ, LAURA (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 N VALLEY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-5121
Mailing Address - Country:US
Mailing Address - Phone:575-527-5083
Mailing Address - Fax:575-527-5093
Practice Address - Street 1:1705 NORTH VALLEY DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5121
Practice Address - Country:US
Practice Address - Phone:575-527-5083
Practice Address - Fax:575-527-5093
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor