Provider Demographics
NPI:1255855748
Name:RODRIGUEZ, GAGE MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:GAGE
Middle Name:MICHAEL
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 1:101 W WASHINGTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2434
Mailing Address - Country:US
Mailing Address - Phone:601-856-2383
Mailing Address - Fax:
Practice Address - Street 1:101 W WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2434
Practice Address - Country:US
Practice Address - Phone:601-856-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor