Provider Demographics
NPI:1336103548
Name:RODRIGUEZ, ENRIQUE TOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:TOMAS
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 1:1840 NW 122ND TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1966
Mailing Address - Country:US
Mailing Address - Phone:954-443-6600
Mailing Address - Fax:954-436-3500
Practice Address - Street 1:1840 NW 122ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1966
Practice Address - Country:US
Practice Address - Phone:954-443-6600
Practice Address - Fax:954-436-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007694111N00000X
FLCH9812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor