Provider Demographics
NPI:1477091981
Name:RODRIGUEZ, TANNER JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:TANNER
Middle Name:JOHN
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 1:6300 RIDGLEA PL
Mailing Address - Street 2:SUITE 408
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-5704
Mailing Address - Country:US
Mailing Address - Phone:817-708-2800
Mailing Address - Fax:817-708-2886
Practice Address - Street 1:6300 RIDGLEA PL
Practice Address - Street 2:SUITE 408
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-5704
Practice Address - Country:US
Practice Address - Phone:817-708-2800
Practice Address - Fax:817-708-2886
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13344111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor