Provider Demographics
NPI:1477188191
Name:RODRIGUEZ, LUIS JESUS X (DC)
Entity Type:Individual
Prefix:
First Name:LUIS JESUS
Middle Name:
Last Name:RODRIGUEZ
Suffix:X
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 1:2085 A1A S STE 103
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6505
Mailing Address - Country:US
Mailing Address - Phone:904-515-2225
Mailing Address - Fax:904-515-2235
Practice Address - Street 1:350 NW 84TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1859
Practice Address - Country:US
Practice Address - Phone:787-564-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor