Provider Demographics
NPI:1679211254
Name:RODRIGUEZ, JEAN (DC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
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 1:1112 ASHBY ST
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-6439
Mailing Address - Country:US
Mailing Address - Phone:787-469-8230
Mailing Address - Fax:
Practice Address - Street 1:22611 MARKEY CT STE 105
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6925
Practice Address - Country:US
Practice Address - Phone:787-469-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557828111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician