Provider Demographics
NPI:1174841407
Name:A. RODRIGUEZ JUANENGO CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:A. RODRIGUEZ JUANENGO CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:JUANENGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-577-0558
Mailing Address - Street 1:10877 WESTONHILL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2725
Mailing Address - Country:US
Mailing Address - Phone:858-577-0558
Mailing Address - Fax:858-549-2376
Practice Address - Street 1:3641 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1514
Practice Address - Country:US
Practice Address - Phone:619-280-0435
Practice Address - Fax:619-280-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28799111N00000X
CADC31164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty