Provider Demographics
NPI:1326116336
Name:RODRIGUEZ, RUBEN BENJAMIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:BENJAMIN
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:PO BOX 1933
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1933
Mailing Address - Country:US
Mailing Address - Phone:787-884-5317
Mailing Address - Fax:787-884-5317
Practice Address - Street 1:B39 CALLE ELLIOT VELEZ
Practice Address - Street 2:MARGINAL ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-884-5317
Practice Address - Fax:787-884-5317
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0354111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0060088Medicare ID - Type Unspecified
PRU91424Medicare UPIN