Provider Demographics
NPI:1609016591
Name:ESCOBEDO, ROD J (DC)
Entity Type:Individual
Prefix:
First Name:ROD
Middle Name:J
Last Name:ESCOBEDO
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 1:179 E 17TH ST
Mailing Address - Street 2:#A
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3724
Mailing Address - Country:US
Mailing Address - Phone:949-722-7572
Mailing Address - Fax:949-722-7603
Practice Address - Street 1:179 E 17TH ST
Practice Address - Street 2:#A
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3724
Practice Address - Country:US
Practice Address - Phone:949-722-7572
Practice Address - Fax:949-722-7603
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor